Ohio
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

View reimbursement policies online at anthem.com

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

View reimbursement policies online at anthem.com

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

Updates to AIM Spine Surgery Clinical Appropriateness Guideline*

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

Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines*

*Notice of Material Amendment/Change to Contract (MAC)
January 2023 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines*

*Notice of Material Amendment/Change to Contract (MAC)
January 2023 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guideline*

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

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline*

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

Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines*

*Notice of Material Amendment/Change to Contract (MAC)
January 2023 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines*

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

Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines - Material adverse change*

*Notice of Material Amendment/Change to Contract (MAC)
January 2023 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Dec 30, 2022

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines*

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

February 2023 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 1, 2023

Updates to AIM sleep disorder management clinical appropriateness guidelines*

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

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 Sleep Disorder Management 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 Radiation Oncology: Proton Beam Therapy Clinical Appropriateness Guideline

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

Updates to AIM Radiation Oncology clinical appropriateness guideline*

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

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

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines*

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

Updates to AIM musculoskeletal clinical appropriateness guidelines*

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

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 Cardiology clinical appropriateness guidelines*

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

Updates to AIM Advanced Oncologic Imaging Clinical Appropriateness Guideline

August 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Aug 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 Advanced Imaging Clinical Appropriateness Guidelines*

July 2019 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Jul 1, 2019

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

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

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 advanced imaging clinical appropriateness guidelines*

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

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

February 2020 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Feb 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 Advanced Imaging Clinical Appropriateness Guideline*

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

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline*

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

Updated guidance on prior authorization requirements for admissions to in-network long-term acute care hospitals (LTACHs)*

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

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

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

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

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

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

Update: Drug Screen Testing - Professional*

May 2019 Anthem Provider Newsletter - Ohio Reimbursement Policies May 1, 2019

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

Update: AIM Musculoskeletal Program effective November 1, 2021 - Site of care reviews*

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

Update to evaluation and management services correct coding - Professional

June 2021 Anthem Provider News - Ohio Reimbursement Policies Jun 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

Update to AIM Sleep Disorder Management Clinical Appropriateness Guidelines*

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

Update to AIM Musculoskeletal Program Clinical Appropriateness Guidelines*

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

Update to AIM Musculoskeletal Joint Surgery Clinical Appropriateness Guidelines*

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

Update to AIM Advanced Imaging of the Heart Clinical Appropriateness Guideline*

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

Update to AIM Advanced Imaging of the Head and Neck Clinical Appropriateness Guidelines*

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

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

Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline

November 2022 Anthem Provider News - Ohio Medical Policy & Clinical Guidelines Nov 1, 2022

Transition to AIM Specialty Health imaging of the heart clinical appropriateness guideline for computed tomography to detect coronary artery calcification

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

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines*

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

Transition to AIM Rehabilitative Services clinical appropriateness guidelines

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

Transition to AIM rehabilitative service clinical appropriateness guidelines

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

System updates for 2020 (Professional)

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

RETRACTION: Inpatient Facility Transfers - facility reimbursement policy

December 2021 Anthem Provider News - Ohio Reimbursement Policies Dec 1, 2021

Retraction for reimbursement policy: Sexually Transmitted Infections - Professional

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

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

Reminder: Post-service reviews using AIM

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

REMINDER: AIM Rehabilitative Program Pediatric Exclusions

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

Reminder about system updates

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

Reimbursement Policy Updates: February 2019*

February 2019 Anthem Ohio Provider Newsletter Reimbursement Policies Feb 1, 2019

Reimbursement Policy Updates - December 2018

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

Reimbursement policy update: Virtual Visits - Professional and Facility

December 2021 Anthem Provider News - Ohio Reimbursement Policies Dec 1, 2021

Reimbursement policy update: Virtual Visits (Professional and Facility)*

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

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

January 2021 Anthem Provider News - Ohio Reimbursement Policies Jan 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

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

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

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

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

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

Reimbursement policy update: Three-Dimensional (3D) Radiology Services - Professional and Facility

October 2022 Anthem Provider News - Ohio Reimbursement Policies Oct 1, 2022

Reimbursement policy update: Sexually transmitted infections testing - Professional*

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

Reimbursement Policy update: Place of Service-Professional*

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

Reimbursement policy update: Place of Service - Facility*

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

Reimbursement policy update: Outpatient facility claim edits

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

Reimbursement policy update: Multiple diagnostic imaging procedures - Professional*

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

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

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

Reimbursement policy update: Modifier Rules - Professional*

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

Reimbursement policy update: Modifier Rules - Professional*

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

Reimbursement policy update: Modifier Rules - Professional*

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

Reimbursement policy update: Modifier rules (Professional)*

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

Reimbursement policy update: Modifier 66: Surgical Teams - Professional

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

Reimbursement policy update: Laboratory and venipuncture services - professional and facility*

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

Reimbursement policy update: Laboratory and venipuncture (Professional)*

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

Reimbursement Policy Update: Injectable Substances with Related Injection Services - Professional*

February 2019 Anthem Ohio Provider Newsletter Reimbursement Policies Feb 1, 2019

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: Frequency Editing-Professional*

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

Reimbursement Policy Update: Frequency Editing -- Professional*

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

Reimbursement policy update: Frequency editing - Professional*

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

Reimbursement policy update: Frequency Editing (Professional)*

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

Reimbursement policy update: Emergency Room Transfers - Facility*

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

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: Drug Screen Testing - Professional*

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

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: 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 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: Consultations - Professional*

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

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