Ohio
Provider Communications

May 2021 Anthem Provider News - Ohio

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Title Category

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - May 2021

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
Administrative

Specialty pharmacy prior authorization update - Certain drugs for treatment of ocular conditions continue to require prior authorization*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy

Updates for specialty pharmacy are available - May 2021*

*Notice of Material Amendment/Change to Contract (MAC)
Pharmacy

Resources to support diverse patients and communities

Administrative

Referring to network DME providers for negative pressure wound therapy helps members save on out-of-pocket costs

Administrative

2021 Affirmative statement regarding utilization management decisions

Administrative

A helpful and complete guide to covered well-child visits

Administrative

May is National High Blood Pressure Education Month

Administrative

Digital online scheduling feature now available in the Availity Portal

Administrative

Provider bulletins for medical and itemized bill attachments: Electronic solutions at your fingertips

Administrative

Sending larger digital attachments through Availity

Administrative

New prior authorization requirement: Kidney transplantation*

*Notice of Material Amendment/Change to Contract (MAC)
Medical Policy & Clinical Guidelines

Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines

Medical Policy & Clinical Guidelines

Updated AIM rehabilitative program effective August 1, 2021 - Initial evaluations and site of service reviews*

*Notice of Material Amendment/Change to Contract (MAC)
Medical Policy & Clinical Guidelines

Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

Medical Policy & Clinical Guidelines

Reimbursement policy update: Claims Requiring Additional Documentation - Facility*

*Notice of Material Amendment/Change to Contract (MAC)
Reimbursement Policies

Reimbursement policy reminder: Readmission - Facility

Reimbursement Policies

Reimbursement policy update: Frequency editing - Professional

Reimbursement Policies

Keep up with Medicare news - May 2021

View these Medicare articles:
- Anthem working with Optum to collect medical records for Medicare Risk Adjustment (MRA)
- Helping our senior members
- Updates to the AIM Specialty Health musculoskeletal program clinical appropriateness guidelines
Medicare

Maximizing efficient, high quality COVID-19 screenings

Medicare
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