Ohio
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

Medical Policy and Clinical Guideline Updates - July 2021*

*Notice of Material Amendment/Change to Contract (MAC)
July 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2021

Reminder: Updated AIM rehabilitative program effective August 1, 2021 - Site of service reviews

July 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2021

New reimbursement policy: Non-patient laboratory services - Facility*

*Notice of Material Amendment/Change to Contract (MAC)
July 2021 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2021

Reimbursement policy update: Consultations - Professional*

*Notice of Material Amendment/Change to Contract (MAC)
July 2021 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2021

Medical policy and clinical guideline updates - June 2021*

*Notice of Material Amendment/Change to Contract (MAC)
June 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2021

Prior authorization for genetic testing medical policy effective September 1, 2021*

*Notice of Material Amendment/Change to Contract (MAC)
June 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM advanced imaging clinical appropriateness guidelines*

*Notice of Material Amendment/Change to Contract (MAC)
June 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM musculoskeletal program clinical appropriateness guidelines*

*Notice of Material Amendment/Change to Contract (MAC)
June 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2021

Update to evaluation and management services correct coding - Professional

June 2021 Anthem Provider News - Ohio Reimbursement Policies Jun 1, 2021

Continuation of skilled nursing facility (SNF) process in Indiana and Ohio

June 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2021

New Back Pain Management Program effective July 19, 2021

June 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2021

Reimbursement policy update: Outpatient facility claim edits

June 2021 Anthem Provider News - Ohio Reimbursement Policies Jun 1, 2021

New prior authorization requirement: Kidney transplantation*

*Notice of Material Amendment/Change to Contract (MAC)
May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2021

Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines

May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 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)
May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2021

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

May 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation - Facility*

*Notice of Material Amendment/Change to Contract (MAC)
May 2021 Anthem Provider News - Ohio Reimbursement Policies May 1, 2021

Reimbursement policy reminder: Readmission - Facility

May 2021 Anthem Provider News - Ohio Reimbursement Policies May 1, 2021

Reimbursement policy update: Frequency editing - Professional

May 2021 Anthem Provider News - Ohio Reimbursement Policies May 1, 2021

Medical policy and clinical guideline updates - April 2021*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

Update: Clinical guideline adoption postponed*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

MCG Care Guidelines 25th Edition available*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

Maximizing efficient, high quality COVID-19 screenings*

*Notice of Material Amendment/Change to Contract (MAC)
COVID-19 Information - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

Update for Commercial providers: AIM sleep program CPT code E1399, NOC: Durable medical equipment, miscellaneous

April 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2021

New reimbursement policy: Newborn Inpatient Stays for facilities*

*Notice of Material Amendment/Change to Contract (MAC)
April 2021 Anthem Provider News - Ohio Reimbursement Policies Apr 1, 2021

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

March 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Mar 1, 2021

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

March 2021 Anthem Provider News - Ohio Reimbursement Policies Mar 1, 2021

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

*Material Adverse Change (MAC)
March 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Mar 1, 2021

Medical Policy and Clinical Guideline Updates - February 2021*

February 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 1, 2021

Reimbursement policy update: Emergency Room Transfers - Facility*

February 2021 Anthem Provider News - Ohio Reimbursement Policies Feb 1, 2021

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility*

February 2021 Anthem Provider News - Ohio Reimbursement Policies Feb 1, 2021

Medical Policy and Clinical Guideline Updates - January 2021*

January 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jan 1, 2021

MCG Care Guidelines 24th Edition Customization*

January 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jan 1, 2021

Anthem implements pilot program for in-network skilled nursing facilities (SNF)

January 2021 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jan 1, 2021

Reimbursement policy update: Multiple diagnostic imaging procedures - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Frequency editing - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Guidelines for reporting timed units for physical medicine and rehabilitation - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Modifier Rules - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Unit frequency maximum for drugs and biologicals - Professional*

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2021

Medical policy and clinical guideline updates - December 2020*

December 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2020

Anthem expands hospice policy

December 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Cardiology clinical appropriateness guidelines*

December 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Advanced Imaging clinical appropriateness guideline*

December 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Radiation Oncology clinical appropriateness guideline*

December 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2020

Transition to AIM Rehabilitative Services clinical appropriateness guidelines

December 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2020

Clinical practice and preventive health guidelines available on anthem.com

December 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2020

Reimbursement policy update: Bundled services and supplies (Professional)*

December 2020 Anthem Provider News - Ohio Reimbursement Policies Dec 1, 2020

Medical policy and clinical guideline updates - November 2020*

November 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2020

Correction to Prior Authorization Update for Commercial business*

November 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2020

Reminder: Post-service reviews using AIM

November 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2020

New reimbursement policy: Documentation standards for episodes of care (Professional)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Modifier rules (Professional)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Bundled services and supplies (Professional)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Multiple diagnostic imaging facility (Facility)*

November 2020 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2020

Medical policy and clinical guideline updates - October 2020*

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Prior authorization update for Commercial Individual Business*

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Transition to AIM rehabilitative service clinical appropriateness guidelines

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Reminder: Expansion of AIM Musculoskeletal Program effective November 1, 2020

October 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Oct 1, 2020

Reimbursement policy update: Emergency department - leveling of Evaluation and Management services (Facility)*

October 2020 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Claims requiring additional documentation policy (Facility)

October 2020 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Laboratory and venipuncture (Professional)*

October 2020 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2020

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

September 2020 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2020

Reimbursement policy update: Frequency Editing (Professional)*

September 2020 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2020

Medical policy and clinical guideline updates - August 2020*

August 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2020

Expansion of AIM Musculoskeletal Program effective November 1, 2020*

August 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2020

Reimbursement Policy Update: Claims requiring additional documentation (Facility)*

August 2020 Anthem Provider News - Ohio Reimbursement Policies Aug 1, 2020

New MCG 24th Edition Guidelines

July 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2020

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations*

July 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2020

Medical Policy and Clinical Guideline Updates - June 2020*

June 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2020

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines*

June 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2020

REMINDER: AIM Rehabilitative Program Pediatric Exclusions

June 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2020

New Reimbursement Policies: Nurse Practitioner and Physician Assistant Services (Professional)*

June 2020 Anthem Provider News - Ohio Reimbursement Policies Jun 1, 2020

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM MSK Interventional Pain Management Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Musculoskeletal Program Joint Surgery Clinical Appropriateness Guidelines*

May 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2020

Reimbursement Policy Update: Claims requiring additional documentation (Facility)*

May 2020 Anthem Provider News - Ohio Reimbursement Policies May 1, 2020

Reminder about system updates

May 2020 Anthem Provider News - Ohio Reimbursement Policies May 1, 2020

MCG Care Guidelines 24th Edition*

April 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2020

UPDATE: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements*

April 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Apr 1, 2020

Medical Policy and Clinical Guideline Updates - February 2020*

February 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 1, 2020

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

February 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 1, 2020

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines*

February 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 1, 2020

Important Update: Milliman Care Guideline (MCG), 23rd Edition, ORG: W0163 Pelvic Organ Prolapse Repair*

January 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jan 1, 2020

Outpatient Facility Edit Implementation*

January 2020 Anthem Provider News - Ohio Reimbursement Policies Jan 1, 2020

New Reimbursement Policies: Durable Medical Equipment, Rent to Purchase Durable Medical Equipment, and Modifiers (Professional)

December 2019 Anthem Provider News - Ohio Reimbursement Policies Dec 1, 2019

System updates for 2020 (Professional)

December 2019 Anthem Provider News - Ohio Reimbursement Policies Dec 1, 2019

Medical Policy and Clinical Guidelines Updates -- November 2019*

November 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guideline*

November 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Radiation Therapy Clinical Appropriateness Guideline*

November 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Spine Surgery Clinical Appropriateness Guideline*

November 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline*

November 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2019

Reimbursement Policy update: Place of Service-Professional*

October 2019 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2019

Clinical Guideline Updates -- September 2019*

September 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Sep 1, 2019

New Reimbursement Policies: Maternity Services and Multiple Delivery - Professional*

September 2019 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2019

New Reimbursement Policy: Intensity Modulated Radiation Therapy Planning and Delivery - Professional*

September 2019 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2019

Claim editing update for Excludes1 notes

September 2019 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2019

Medical Policy and Clinical Guideline Updates -- August 2019*

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019

Anthem customizations to MCG care guidelines 23rd edition*

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 1, 2019
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