CommercialMarch 1, 2021

March 2021 Anthem Provider News - Ohio

Administrative

AdministrativeCommercialMarch 1, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - March 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.

AdministrativeCommercialMarch 1, 2021

Medical attachment capability now includes itemized bills and more!

Policy Updates

Medical Policy & Clinical GuidelinesCommercialMarch 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery guideline

Medical Policy & Clinical GuidelinesCommercialMarch 1, 2021

Anthem clarifies guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)*
*Material Adverse Change (MAC)

Reimbursement PoliciesCommercialMarch 1, 2021

Claims editing update for ICD-10-CM Excludes 1 notes

Products & Programs

PharmacyCommercialMarch 1, 2021

Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021*
*Material Adverse Change (MAC)

PharmacyCommercialMarch 1, 2021

Updates for specialty pharmacy are available - March 2021*
*Material Adverse Change (MAC)

PharmacyCommercialMarch 1, 2021

Some HIV medication combinations may require prior authorization

State & Federal

State & FederalMedicare AdvantageMarch 1, 2021

Medicare News - March 2021
View these Medicare articles:
- MCG Care Guidelines 24th edition customization
- DME checklist of information needed from providers

State & FederalMedicare AdvantageMarch 1, 2021

Access to more claim denial information is now self-service

State & FederalMedicare AdvantageMarch 1, 2021

New provider directory indicator for telehealth services

State & FederalMedicare AdvantageMarch 1, 2021

Medical policies and clinical utilization management guidelines update