Virginia
Provider Communications

Radiology prior authorization review transitioned to AIM; prior authorization required

Prior authorization requirement changes effective August 1, 2022

MCG care guidelines 26th edition

Antibiotic dispensing guidelines

Update use of modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services

Change to Department of Medical Assistance Services’ incontinence undergarment benefit limits

Keep up with Medicaid news: July 2022

• Updating member information
• Use of Imaging Studies for Low Back Pain (LBP)
• Remote patient monitoring update
• Prior authorization updates for medications billed under the medical benefit
• Virginia Medicaid language interpretation services

Update use of modifier 25 for billing for visits that include preventive services and problem-oriented evaluation and management services

Cancer Care Navigator

Keep up with Medicare news: July 2022

• New specialty pharmacy medical step therapy requirements

Process change for Federal Employee Program® third-party correspondence requests

Provider notice for COVID-19 testing

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Medical drug benefit Clinical Criteria updates

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Medicaid news: June 2022

• Transcranial magnetic stimulation provider communication
• Prior authorization update for select durable medical equipment (DME) items
• MES and DMAS enrollment requirement
• Updates to AIM Specialty Health Sleep Disorder Management Clinical Appropriateness Guidelines
• Prior authorization updates for medications billed under the medical benefit
• Precertification requirement notice

Provider notice for COVID-19 testing

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Authorizations for post-acute care services for Medicare Advantage individual, Group Retiree Solutions (GRS), and Dual-Eligible Plan members

Medical drug benefit Clinical Criteria updates

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Medicare news: June 2022

• Updates to AIM Specialty Health Sleep Disorder Management Clinical Appropriateness Guidelines
• New specialty pharmacy medical step therapy requirements
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• Updates to AIM Specialty Health Musculoskeletal Clinical Appropriateness Guidelines

Federal Employee Program® AIM radiology prior authorization review reminder

CORRECTION: Save time by using CPT II codes: Introducing FEP® Quality Reimbursement Program for PPO providers

Join us for a FEP® Quality Learning Program live webinar

Screening for alcohol use disorder in high-prevalence demographics

Personal care services prior authorization change

Keep up with Medicaid news: May 2022

• DMAS MEMO: Medicaid Enterprise System
• Prior authorization requirement change for HCPCS code K1022
• New specialty pharmacy medical step therapy requirements

Convenient, reliable at-home testing for colorectal cancer and diabetes care

HEDIS 2022: Summary of changes from the National Committee for Quality Assurance

New specialty pharmacy medical step therapy requirements

Keep up with Medicare news: May 2022

• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list effective July 1, 2022
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements effective June 1, 2022

Save time by using CPT II codes: Introducing FEP Quality Reimbursement Program for PPO providers

The Anthem, Inc. name is changing

Claims reprocessing update for home- and community-based services

Reminder: Provider orientations are available

Disease Management/Population Health program

Clinical Criteria updates

Keep up with Medicaid news: April 2022

• Prior authorization updates for medications billed under the medical benefit
• Medical drug benefit Clinical Criteria updates
• Improving the lives of our members: Social drivers of health
• Medical Policies and Clinical Utilization Management Guidelines update

The Anthem, Inc. name is changing

Model of Care required training

The impact of listening

Clinical Criteria updates

Implementation update for the NYC Medicare Advantage Plus plan, an alliance between Empire BlueCross BlueShield and EmblemHealth

Keep up with Medicare news: April 2022

• Medical Policies and Clinical Utilization Management Guidelines update
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates

Implementation update for the NYC Medicare Advantage Plus plan, an alliance between Empire BlueCross BlueShield and EmblemHealth

Change to the Federal Employee Program® clinical grievance and appeal address

HEDIS 2022 Federal Employee Program® medical record request requirements

Urinary tract infection toolkits are on the way

It is CAHPS survey time

Annual wellness visits for Medicare Advantage members

Pharmacy newsletter

Clinical Criteria updates

Prior authorization requirement changes effective June 1, 2022

Keep up with Medicare news: March 2022

• Medical step therapy updates

Notice of Regulatory Amendment related to Medicaid participating providers and facilities

Reminder: Provider orientations are available

The Behavioral Health Areas of Expertise Profile improves the referral process

Get faster payments with electronic funds transfer

Keep up with Medicaid news: February 2022

• Provider Services Solution (PRSS)
• Enrollment and maintenance changes starting April 2022
• State Memo: December 1, 2021, Behavioral Health Enhancement (BHE) Licensed Services
• State memo: Important changes to emergency services licenses
• Cancer Care Navigator

Get faster payments with electronic funds transfer

Keep up with Medicare news: February 2022

• NYC Medicare Advantage Plus update
• Cancer Care Navigator

2022 FEP® Benefit information available online

Botox® update for Anthem HealthKeepers Plus members

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

2021 CAHPS Survey results

Submitting prior authorizations is getting easier

Keep up with Medicaid news: January 2022

• Provider orientations and training
• Prior authorization updates for medications billed under the medical benefit effective March 1, 2022
• Prior authorization updates for medications billed under the medical benefit
• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines update
• Change to durable medical equipment wheelchair benefit limits
• HEDIS Guide for retinal exam using fundoscopic photograph

Reducing the burden of medical record review and improving health outcomes with HEDIS ECDS reporting

Important update on Botox® for Medicare members of Anthem Blue Cross and Blue Shield

Volvo Group North American offers Medicare Advantage option

Availity authorization app available to Anthem Blue Cross and Blue Shield providers in 2022

Keep up with Medicare news: January 2022

• Medical step therapy updates
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines update

Reimbursement policy update: Drug Screen Testing

HEDIS measures: Follow-up after ED visits for mental illness and alcohol and drug dependency

Healthy Rewards reminder for providers

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

Medical Policies and Clinical Utilization Management Guidelines update

Change to durable medical equipment wheelchair benefit limits

Non-payment remittance advice enhancements

Keep up with Medicaid news: December 2021

• Durable medical equipment prior authorization requirement changes effective December 1, 2021
• Prior authorization requirement changes
• Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines
• Medical drug benefit Clinical Criteria updates
• Important information regarding behavioral health project BRAVO implementation
• Home delivery pharmacy reminder

Non-payment remittance advice enhancements

Reimbursement policy: Drug screen testing

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

2022 Medicare Advantage service area and benefit updates

Keep up with Medicare news: December 2021

• Updates to AIM Specialty Health musculoskeletal interventional pain management
  clinical appropriateness guideline
• Medical drug benefit Clinical Criteria updates
• Protocol for providers serving members with hearing aid coverage administered by Hearing Care Solutions
• New York City Medicare Advantage announcement
• Medical Policies and Clinical Utilization Management Guidelines update

Electronic data interchange process

Clinical Criteria updates

Unspecified diagnosis reminder

4 things you can do to encourage cancer screenings for your women patients

Keep up with Medicaid news: November 2021

• FAQ: New AIM Specialty Health contact center phone number
• Behavioral therapy assessments
• Change to DME incontinence benefit limits
• Prior authorization updates for specialty pharmacy

Medicare Advantage telehealth rural health center and federally qualified health center claims

Electronic data interchange process

Clinical Criteria updates

Anthem Blue Cross and Blue Shield offering Advance Medical Directives program for 2022

Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines

New York City Medicare Advantage announcement

Keep up with Medicare news: November 2021

• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

New Medicare Advantage plan will have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing providers nationally

Effective January 1, 2022, approximately 240,000 Medicare-eligible City of New York retirees across the United States will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan and have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing. Read important information about this change in the New York City Medicare Advantage announcement.

Diabetes testing and screening HEDIS measures