Ohio
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT Code List update*

*Notice of Material Amendment/Change to contract (MAC)
December 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2022

AIM Specialty Health Outpatient Rehabilitative and Habilitative Services clinical appropriateness guidelines updates*

*Notice of Material Amendment/Change to Contract (MAC)
March 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Mar 1, 2022

Anthem adopts neonatal level of care reviews (Neonatal Levels of Care, CG-MED-26)

November 2018 Anthem Ohio Network eUpdate Medical Policy & Clinical Guidelines Nov 1, 2018

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

Anthem customizations to MCG care guidelines 23rd edition*

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

Anthem expands hospice policy

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

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

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

Claim editing update for Excludes1 notes

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

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

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

Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation - professional

November 2021 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2021

Clinical Guideline Update - May 2019*

May 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines May 1, 2019

Clinical Guideline Updates -- September 2019*

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

Clinical practice and preventive health guidelines available on anthem.com

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

Clinical practice and preventive health guidelines available on anthem.com

December 2018 Anthem Ohio Provider Newsletter Medical Policy & Clinical Guidelines Dec 1, 2018

Clinical Validation: Professional*

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

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

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

Correction to Prior Authorization Update for Commercial business*

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

Correction to reimbursement policy: Place of Service - Facility

Notice of Material Amendment/Change to Contract (MAC)

November 2022 Anthem Provider News - Ohio Reimbursement Policies Nov 1, 2022

Expansion of AIM Musculoskeletal Program effective November 1, 2020*

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

ICD-10-CM Coding Guidelines and Laterality: Professional

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

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

Maximizing efficient, high quality COVID-19 screenings*

*Notice of Material Amendment/Change to Contract (MAC)
COVID-19 Information - Ohio – Publication RETIRED as of November 8, 2022 Medical Policy & Clinical Guidelines Apr 1, 2021

MCG care guidelines 23rd Edition*

May 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines May 1, 2019

MCG Care Guidelines 24th Edition Customization*

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

MCG Care Guidelines 24th Edition*

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

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

MCG Care Guidelines 26th Edition*

*Notice of Material Amendment/Change to Contract (MAC)
May 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines May 1, 2022

Medical Polices and Clinical Guidelines Updates - December 2018

December 2018 Anthem Ohio Provider Newsletter Medical Policy & Clinical Guidelines Dec 1, 2018

Medical Policies and Clinical Guidelines updates - December 2022*

*Notice of Material Amendment/Change to contract (MAC)
December 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 1, 2022

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

Medical policy and clinical guideline updates - August 2020*

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

Medical policy and clinical guideline updates - December 2020*

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

Medical policy and clinical guideline updates - December 2021*

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

Medical Policy and Clinical Guideline Updates - February 2020*

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

Medical Policy and Clinical Guideline Updates - February 2021*

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

Medical policy and clinical guideline updates - February 2022*

*Notice of Material Amendment/Change to Contract (MAC)
February 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 1, 2022

Medical Policy and Clinical Guideline Updates - January 2021*

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

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

Medical Policy and Clinical Guideline Updates - June 2020*

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

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

Medical policy and clinical guideline updates - June 2022*

*Notice of Material Amendment/Change to Contract (MAC)
June 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jun 1, 2022

Medical policy and clinical guideline updates - November 2020*

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

Medical policy and clinical guideline updates - November 2022

Notice of Material Amendment/Change to Contract (MAC)
November 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2022

Medical policy and clinical guideline updates - October 2020*

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

Medical policy and clinical guideline updates - October 2021*

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

Medical Policy and Clinical Guideline Updates -- August 2019*

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

Medical Policy and Clinical Guideline Updates -- June 2019*

June 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Jun 1, 2019

Medical policy and clinical guideline updates – September 2022*

*Notice of Material Amendment/Change to Contract (MAC)
September 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Sep 1, 2022

Medical Policy and Clinical Guidelines Updates

October 2018 Anthem Ohio Provider Newsletter Medical Policy & Clinical Guidelines Sep 28, 2018

Medical Policy and Clinical Guidelines Updates - April 2019*

April 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Apr 1, 2019

Medical Policy and Clinical Guidelines Updates -- November 2019*

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

Medical Policy and Clinical Guidelines: February 2019*

February 2019 Anthem Ohio Provider Newsletter Medical Policy & Clinical Guidelines Feb 1, 2019

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

Modifier 63 reminder: Professional

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

Modifier 79 reminder: Professional

July 2019 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2019

New Back Pain Management Program effective July 19, 2021

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

New Clinical Guideline: Inpatient Inter-Facility Transfers effective September 1, 2019*

June 2019 Anthem Provider Newsletter - Ohio Medical Policy & Clinical Guidelines Jun 1, 2019

New MCG 24th Edition Guidelines

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

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

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

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

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

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

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

New Reimbursement Policy - Facility Revenue Code Billing

October 2018 Anthem Ohio Provider Newsletter Reimbursement Policies Sep 28, 2018

New reimbursement policy update: Inpatient Facility Transfers - Facility* - RETRACTION

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

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - Professional*

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

New Reimbursement Policy: Ambulance Transportation -- Professional*

June 2019 Anthem Provider Newsletter - Ohio Reimbursement Policies Jun 1, 2019

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

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

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

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

New reimbursement policy: Modifier FB - Professional and Facility*

*Notice of Material Amendment/Change to Contract (MAC)
July 2022 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2022

New reimbursement policy: Multiple and Bilateral Surgery Processing - Facility*

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

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

New Reimbursement Policy: Partial Hospitalization Program and Intensive Outpatient Program Services Facility*

April 2019 Anthem Provider Newsletter - Ohio Reimbursement Policies Apr 1, 2019

New reimbursement policy: Transitional Care Management - professional

July 2022 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2022

Outpatient Facility Edit Implementation*

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

Pre-Service/Prior Authorization Clinical Review Update: February 2019*

February 2019 Anthem Ohio Provider Newsletter Medical Policy & Clinical Guidelines Feb 1, 2019

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

Prior authorization update for Commercial Individual Business*

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

Reimbursement policy clarification: Claims requiring additional documentation - Facility

October 2021 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2021

Reimbursement policy reminder: Readmission - Facility

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

Reimbursement Policy Update - Readmissions (Facility)

October 2018 Anthem Ohio Provider Newsletter Reimbursement Policies Sep 28, 2018

Reimbursement Policy Update - Scope of License (Professional)

December 2018 Anthem Ohio Provider Newsletter Reimbursement Policies Dec 1, 2018

Reimbursement policy update: Frequency editing - Professional

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

Reimbursement policy update: Multiple and Bilateral Surgery Processing - Professional

Notice of Material Amendment/Change to Contract (MAC)
October 2022 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2022

Reimbursement policy update: Multiple Surgery - Facility

December 2022 Anthem Provider News - Ohio Reimbursement Policies Dec 1, 2022

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - Professional

September 2022 Anthem Provider News - Ohio Reimbursement Policies Sep 1, 2022

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - Professional*

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

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

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

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

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

Reimbursement policy update: Bundled Services and Supplies - Professional*

*Notice of Material Amendment/Change to contract (MAC)

December 2022 Anthem Provider News - Ohio Reimbursement Policies Dec 1, 2022

Reimbursement Policy Update: Bundled Services-Professional*

August 2019 Anthem Provider News - Ohio Reimbursement Policies Aug 1, 2019

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

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

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

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

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

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

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 update: Claims requiring additional documentation policy (Facility)

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

Reimbursement policy update: Consultations - Professional*

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

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, & XU*

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

Reimbursement policy update: Distinct Procedural Service, Modifiers 59, XE, XP, XS, XU - professional*

*Notice of Material Amendment/Change to Contract (MAC)
July 2022 Anthem Provider News - Ohio Reimbursement Policies Jul 1, 2022

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

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