December 30, 2022

January 2023 Anthem Provider News - Ohio

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Administrative

AdministrativeCommercialDecember 30, 2022

Professional system updates for 2023

AdministrativeCommercialDecember 30, 2022

Outpatient system updates for 2023

AdministrativeCommercialMedicare AdvantageDecember 30, 2022

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Notification regarding reimbursement changes to COVID-19 laboratory services codes

AdministrativeCommercialMedicare AdvantageDecember 30, 2022

Childhood Immunization Status and Lead Screening in Children for HEDIS

AdministrativeCommercialDecember 30, 2022

Remittance advice message enhancements: Providing clear descriptions and actionable next steps

Policy Updates

Medical Policy & Clinical GuidelinesCommercialDecember 30, 2022

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update 

Medical Policy & Clinical GuidelinesCommercialDecember 30, 2022

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines 

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 30, 2022

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 30, 2022

Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines*
*Notice of Material Amendment/Change to Contract (MAC)

Medical Policy & Clinical GuidelinesCommercialDecember 30, 2022

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines 

Reimbursement PoliciesCommercialDecember 30, 2022

Outpatient facility revenue code billing requirements

Products & Programs

Federal Employee Program (FEP)CommercialDecember 30, 2022

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Federal Employee Program observation conversion for musculoskeletal cases

PharmacyCommercialDecember 30, 2022

Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements

Specialty pharmacy updates

State & Federal

State & FederalMedicaid Managed CareDecember 30, 2022

This is Quitting: Helping teens and young adults quit vaping

State & FederalMedicaid Managed CareDecember 30, 2022

Anthem Blue Cross and Blue Shield provider orientations

State & FederalMedicare AdvantageDecember 30, 2022

Cleveland-Cliffs offers Medicare Advantage option

State & FederalMedicare AdvantageDecember 30, 2022

Keep up with Medicare news - January 2023
- Prior authorization requirement changes
- New specialty pharmacy medical step therapy requirements (Inflectra & Renflexis)
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Cimerli)
- Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines