May 1, 2021

May 2021 Anthem Provider News - Ohio

Administrative

AdministrativeCommercialMay 1, 2021

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.

AdministrativeCommercialMay 1, 2021

Resources to support diverse patients and communities

AdministrativeCommercialMay 1, 2021

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

AdministrativeCommercialMay 1, 2021

2021 Affirmative statement regarding utilization management decisions

AdministrativeCommercialMay 1, 2021

A helpful and complete guide to covered well-child visits

AdministrativeCommercialMay 1, 2021

May is National High Blood Pressure Education Month

AdministrativeCommercialMay 1, 2021

Digital online scheduling feature now available in the Availity Portal

AdministrativeCommercialMay 1, 2021

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

AdministrativeCommercialMay 1, 2021

Sending larger digital attachments through Availity

Policy Updates

Medical Policy & Clinical GuidelinesCommercialMay 1, 2021

New prior authorization requirement: Kidney transplantation*
*Notice of Material Amendment/Change to Contract (MAC)

Medical Policy & Clinical GuidelinesCommercialMay 1, 2021

Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines

Medical Policy & Clinical GuidelinesCommercialMay 1, 2021

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 GuidelinesCommercialMay 1, 2021

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

Reimbursement PoliciesCommercialMay 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation - Facility*
*Notice of Material Amendment/Change to Contract (MAC)

Reimbursement PoliciesCommercialMay 1, 2021

Reimbursement policy reminder: Readmission - Facility

Reimbursement PoliciesCommercialMay 1, 2021

Reimbursement policy update: Frequency editing - Professional

Products & Programs

PharmacyCommercialMay 1, 2021

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)

PharmacyCommercialMay 1, 2021

Updates for specialty pharmacy are available - May 2021*
*Notice of Material Amendment/Change to Contract (MAC)

State & Federal

State & FederalMedicare AdvantageMay 1, 2021

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

State & FederalMedicare AdvantageMay 1, 2021

Maximizing efficient, high quality COVID-19 screenings