Virginia
Provider Communications

Reminder: Updated Carelon Medical Benefits Management, Inc. Musculoskeletal Program effective April 1, 2023 - Site of care reviews

Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update

Controlling High Blood Pressure and Submitting Compliant Readings

Outpatient Facility Revenue Code Billing Requirements - Facility

Advancing Mental Health Equity for Youth & Young Adults

Provider directory - annual audit for NCQA Accreditation

Time to prepare for HEDIS medical record review

Upcoming amendment changes for Commercial reimbursement policies for Virginia

Clinical Criteria updates for specialty pharmacy are available

Specialty pharmacy updates for March 2023

Policy Update: Modifiers 25 and 57 (Policy G-06003, effective 04/01/2023)

Keep up with Medicaid news - March 2023

• Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines
• Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List
• Carelon Medical Benefits Management, Inc. Radiology Clinical Appropriateness Guidelines CPT code list update
• Clinical Criteria updates
• Prior authorization updates for medications billed under the medical benefit (Carvykti)
• Prior authorization updates for medications billed under the medical benefit (Aduhelm)
• Applied behavior analysis

Keep up with Medicare news - March 2023

• Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List in Virginia
• Carelon Medical Benefits Management, Inc.Genetic Testing Clinical Appropriateness Guidelines CPT code list update
• What date to select for inpatient admissions for claims
• Clinical Criteria updates
• New specialty pharmacy medical step therapy requirements
• Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines

Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures

March is National Colorectal Cancer Awareness Month

Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews

Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023

Pharmacy information available on our provider website

Annual planned visits

Controlling High Blood Pressure and Submitting Compliant Readings

Shared savings and transition care management after inpatient discharges

Informational Update Modifier Usage

AIM Specialty Health will transition to Carelon Medical Benefits Management Inc.

Do you offer telehealth services? Let us know!

Enhancing Provider News website and email communications

Have you reviewed your online provider directory information lately?

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements

Clinical Guideline update (effective May 1, 2023)

Anthem Blue Cross and Blue Shield local precertification change in Virginia for HMO

Anthem Blue Cross and Blue Shield local precertification change in Virginia for PPO

Clinical Guidelines update (effective May 1, 2023)

Specialty pharmacy updates - February 2023

Clinical Criteria updates for specialty pharmacy are available

Introducing the Provider Learning Hub

Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023

Keep up with Medicaid news: February 2023

• Prior authorization updates for medications billed under the medical benefit
• Medical Policies and Clinical Utilization Management Guidelines update
• Prior authorization updates for medications billed under the medical benefit
• POS restrictions for BRAVO services
• Direct member medical necessity appeals to HealthKeepers, Inc.
• Patient liability and claims processing

2023 FEP benefit information available online

Introducing the Provider Learning Hub

Keep up with Medicare news - February 2023

• Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (FyInetra)
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Spevigo, Xenpozyme)
• Specialty pharmacy precertification list expansion (Rolvedon, Stimufend)
• New specialty pharmacy medical step therapy requirements
• Prior authorization requirement changes effective April 1, 2023
• Medical Policies and Clinical Utilization Management Guidelines update

Important reminder: New ID cards for many of our Anthem Blue Cross and Blue Shield members

Telephonic-only care allowance extended through April 11, 2023

Anthem Blue Cross and Blue Shield local precertification change in Virginia for HMO

Anthem Blue Cross and Blue Shield local precertification change in Virginia for PPO

Primary care physician after-hours access requirements

Virginia Commercial with Anthem Blue Cross and Blue Shield: local precertification change notification

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

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines

Coverage and Clinical Guidelines update (effective April 1, 2023)

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

Anthem in Virginia’s upcoming amendment will allow posting of Commercial professional reimbursement policies online at anthem.com

Specialty pharmacy updates

Engagement with your patient counts

Childhood Immunization Status and Lead Screening in Children for HEDIS

Monkeypox and smallpox vaccines: Product code on claims

Attention physicians and lab providers: COVID-19 update regarding reimbursement

Submitting prior authorizations digitally through ICR

Implementation of Cardinal Care

Keep up with Medicaid news: January 2023

• This is Quitting: Helping teens and young adults quit vaping
• HEDIS measure for prenatal and postpartum care
• Prior authorization requirement changes updated effective January 1, 2023
• AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update
• Change to vaccine age limitations

Keep up with Medicare news: January 2023

• Prior authorization requirement changes
• New specialty pharmacy medical step therapy requirements
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines

Notification regarding reimbursement changes to COVID-19 laboratory services codes

Submitting prior authorizations digitally through Interactive Care Reviewer

Federal Employee Program observation conversion for musculoskeletal cases

Professional system updates for 2023

Outpatient system updates for 2023

Remittance advice message enhancements: Providing clear descriptions and actionable next steps

Engagement with your patient counts

Childhood Immunization Status and Lead Screening in Children for HEDIS

Attention lab providers: COVID-19 update regarding reimbursement

Coordination of care

Case management program

Important information about utilization management

Signature requirements for laboratory orders or requisitions

IngenioRx will become CarelonRx on January 1, 2023

Reminder - updated AIM Musculoskeletal program effective January 1, 2023 - site of care reviews

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

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update

Reimbursement policy retirement: Acupuncture Billed with Evaluation and Management - Professional

Clinical Criteria updates for specialty pharmacy available

Specialty pharmacy updates - December 2022

Update to the Pregnancy Notification Form

Doula services

Keep up with Medicaid news: December 2022

• Medical drug benefit Clinical Criteria updates
• Medical Policies and Clinical Utilization Management Guidelines update
• Prior authorization updates for medications billed under the medical benefit (Releuko, Vabysmo)
• Prior authorization requirement changes effective January 1, 2023

2023 Medicare Advantage service area and benefit updates

Keep up with Medicare news: December 2022

• Medical drug benefit Clinical Criteria updates
• Medical Policies and Clinical Utilization Management Guidelines update

Member assessment of PCP after-hours messaging in 2022

Member’s assessment of behavioral healthcare after-hours messaging in 2022

Members’ rights and responsibilities

CAA: Timely updates help keep our provider directories current

Clinical practice and preventive health guidelines available on anthem.com

Pharmacy information available on the provider website

Personal home helper benefit ending

Primary care physician searches in Find Care

Provider contract and fee schedule notifications via Availity

Support documentation for AIM prior authorization requests

Post office boxes are being retired because of low usage

Consolidated Appropriations Act: Keep your provider directory information up to date

Claims status message enhancements: Providing clear descriptions and actionable next steps