Anthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

August 2024 Provider Newsletter

Featured Articles

Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

MCG Care Guidelines 28th edition


Administrative

AdministrativeHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

Mutually exclusive places of service

AdministrativeAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

CAA: Providers required to verify their online provider directory information

AdministrativeAnthem Blue Cross and Blue Shield | Medicare AdvantageAugust 1, 2024

ICD-10-CM Excludes1 notes

Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

Save time and get better results with optimized CPT code search in Availity Essentials

Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialJuly 24, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 16, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs

Digital SolutionsAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Coming soon: View your fee schedule in Availity Essentials Payer Spaces

Education & Training

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

Coming soon: Provider e-Learning Resource Center for Payment Integrity

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 12, 2024

Rate changes effective July 1, 2024

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsDecember 1, 2023

LabCorp is the exclusive clinical reference laboratory provider for Anthem HealthKeepers/HealthKeepers Plus HMO members  

Education & TrainingAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

August is National Breastfeeding Month

Education & TrainingHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

Important information regarding legally responsible individuals and related responsibilities for respite care

Guideline Updates

Guideline UpdatesAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 10, 2024

Clinical Criteria updates

Effective August 12, 2024

Guideline UpdatesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 27, 2024

Carelon Medical Benefits Management, Inc. updates effective October 20, 2024

Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 11, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Effective for dates of service on and after November 17, 2024

Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialJune 25, 2024

Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines

Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | Medicare AdvantageJuly 5, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective August 8, 2024

Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Coverage and Clinical Guidelines update

Effective November 1, 2024

Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Notification of authorization fax number changes

Prior AuthorizationHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJune 27, 2024

Prior authorization requirement changes 

Effective August 1, 2024
Code L5615

Prior AuthorizationHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 23, 2024

Prior authorization requirement changes

Effective September 1, 2024
Codes 33263, 33264, 64582, C2616, and S2095

Prior AuthorizationHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsJuly 5, 2024

Prior authorization requirement changes

Effective September 1, 2024
Codes L7510 and L7520

Reimbursement PoliciesAnthem Blue Cross and Blue Shield | Medicare AdvantageAugust 1, 2024

Reimbursement policy update: Modifier 78

Reimbursement PoliciesAnthem Blue Cross and Blue Shield | Medicare AdvantageAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Reimbursement PoliciesHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

Products & ProgramsHealthKeepers, Inc. | Anthem HealthKeepers Plus Medicaid productsAugust 1, 2024

Bringing whole-person care to sickle cell disease management

PharmacyAnthem Blue Cross and Blue Shield | CommercialJuly 25, 2024

Specialty pharmacy updates โ€” February 2024

Note: This article corrects the Clinical Criteria for Spravato (esketamine), which was incorrectly listed in a February 2024 article.

PharmacyAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Specialty pharmacy updates โ€” August 2024

Tevimbra, Tyenne, and Wezlana

PharmacyAnthem Blue Cross and Blue Shield | CommercialAugust 1, 2024

Clinical Criteria updates for specialty pharmacy are available

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