Virginia
Provider Communications

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

Get your payments faster when you sign up for electronic funds transfer

Prior authorization updates for specialty pharmacy

Prior authorization updates for specialty pharmacy

Keep up with Medicaid news: October 2021

• 2021 affirmative statement concerning utilization management decisions
• Medical Policies and Utilization Management Guidelines update
• Generic buprenorphine/naloxone tablets added to Virginia Preferred Drug List

New medical step therapy requirements

Sexually Transmitted Infections Testing: Professional

Information about 2021 Special Needs Plans

Get your payments faster when you sign up for electronic funds transfer

HEDIS® medical record submission made easier with our Remote EMR Access Service

Keep up with Medicare news: October 2021

• 2021 affirmative statement concerning utilization management decisions
• Medical Policies and Utilization Management Guidelines update

Federal Employee Program® AIM Radiology prior authorization review transition delayed until November 1

Keep up with Medicaid news - September 2021

Reimbursement policy update: DRG inpatient facility transfers effective November 30, 2021

Utilization management authorization rule operations

Prior authorization/precertification form notification

Keep up with Medicare news - September 2021

• Clinical Criteria updates notification

Change in email submission of service requests for Federal Employee Program® members

Adding 87081 to Physician Office Lab list

Enrollment for Northern Virginia area is open now through August 31, 2021

Closing gaps in care through telehealth

Keep up with Medicaid news

Preventing claims denials: Shingles vaccine

Know best: Shingles vaccinations are a Medicare Part D benefit whether administered in your office or in the pharmacy

Keep up with Medicare news

Federal Employee Program® AIM radiology prior authorization review

Reimbursement policy: Modifier 90; reference (outside) laboratory and pass-through billing

Attention facilities: Sending admission, discharge and transfer data to HealthKeepers, Inc. results in improved care management for Anthem HealthKeepers Plus patients

Coding spotlight: Mental disorders in childhood

What matters most: Improving the patient experience

Resources to support your diverse patient panel

Suicide prevention and intervention: What you need to know

Prior authorization requirement changes effective September 1, 2021

Prior authorization requirement changes for medical codes 0205U, 0209U, and 0218U effective September 1, 2021

Prior authorization requirement changes for multiple medical codes effective September 1, 2021

Certain specialty medication precertification requests may require additional documentation

Let’s Vaccinate

Medical drug benefit Clinical Criteria updates

Keep up with Medicaid news

Reimbursement policy: Modifier 90; Reference (outside) laboratory and pass-through billing

Attention facilities: Sending admission, discharge and transfer data to Anthem results in improved care management for patients

Let’s Vaccinate

Help increase your vaccination rates and close gaps-in-care with these tools and strategies

Prior authorization requirement changes for codes A0426 and A0428 effective October 1, 2021

Medical drug benefit Clinical Criteria updates

Keep up with Medicare news

DEXA bone scan criteria for the Federal Employee Program

Provider education program survey: Your Voice Counts

MCG care guidelines 25th edition

Keeping up with routine vaccinations during COVID-19

Aspire Health for members in need of palliative care

Trauma: What you need to know

Complex Case Management program

Important information about utilization management

Members’ Rights and Responsibilities Statement

Keep up with Medicaid news

Reimbursement policy: Reminder about inpatient readmissions

Medical Policies and Clinical Utilization Management Guidelines update

Reminders for Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ

Keep up with Medicare news

Sign up to receive email from HealthKeepers, Inc.

Metabolic monitoring and diabetes screening measures for those on antipsychotics medications

Enhanced Ambulatory Patient Group platform update

Continuing medical education/continuing education unit opportunities

Keep up with Medicaid news