Virginia
Provider Communications

March 2023 Anthem Provider News - Virginia

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Title Category

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

Administrative

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

Administrative

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

Administrative

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

Administrative

Controlling High Blood Pressure and Submitting Compliant Readings

Administrative

Provider directory - annual audit for NCQA Accreditation

Administrative

Outpatient Facility Revenue Code Billing Requirements - Facility

Administrative

Advancing Mental Health Equity for Youth & Young Adults

Administrative

Time to prepare for HEDIS medical record review

Administrative

March is National Colorectal Cancer Awareness Month

Administrative

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

Products & Programs

Upcoming amendment changes for Commercial reimbursement policies for Virginia

Reimbursement Policies

Pharmacy information available on our provider website

Pharmacy

Clinical Criteria updates for specialty pharmacy are available

Pharmacy

Specialty pharmacy updates for March 2023

Pharmacy

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

Medicaid

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
Medicaid

Controlling High Blood Pressure and Submitting Compliant Readings

Medicare

Informational Update Modifier Usage

Medicare

Shared savings and transition care management after inpatient discharges

Medicare

Annual planned visits

Medicare

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
Medicare
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