CommercialSeptember 1, 2020

September 2020 Anthem Provider News - Ohio

Administrative

AdministrativeCommercialSeptember 1, 2020

EDI Gateway migration deadline is September 15, 2020

AdministrativeCommercialSeptember 1, 2020

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2020 Prospective Program continues

AdministrativeCommercialSeptember 1, 2020

Patient360 adds care gap alert feedback for medical providers

AdministrativeCommercialSeptember 1, 2020

Enhanced medical records submission process to support claims processing

AdministrativeCommercialSeptember 1, 2020

Providers can now receive and respond to medical record requests for post-pay audit via Change Healthcare’s Assurance Attach Assist Module

AdministrativeCommercialSeptember 1, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - September 2020
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.

AdministrativeCommercialSeptember 1, 2020

Inclusion of AIM-reviewed services in UM reimbursement penalties

AdministrativeCommercialSeptember 1, 2020

New provider directory indicators for medication assisted treatment (MAT) providers

Policy Updates

Reimbursement PoliciesCommercialSeptember 1, 2020

Reimbursement policy update: Frequency Editing (Professional)*

Reimbursement PoliciesCommercialSeptember 1, 2020

Reimbursement policy update: Distinct Procedural Services- Modifiers 59, XE, XP, XS, XU (Professional)*

Products & Programs

Products & ProgramsCommercialSeptember 1, 2020

Predictive analytics guide proactive support to patients undergoing chemotherapy resulting in lowered admissions

Products & ProgramsCommercialSeptember 1, 2020

Meet your Cancer Care Navigator
Anthem’s new cancer support program helps improve outcomes while easing burdens for you and your patients.

Products & ProgramsCommercialSeptember 1, 2020

Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020*

PharmacyCommercialSeptember 1, 2020

Specialty pharmacy updates are available - September 2020*

PharmacyCommercialSeptember 1, 2020

Anthem to update formulary lists for commercial health plan pharmacy benefit

State & Federal

State & FederalMedicare AdvantageSeptember 1, 2020

Medical drug benefit clinical criteria updates

State & FederalMedicare AdvantageSeptember 1, 2020

Update: Notice of changes to the AIM musculoskeletal program