Virginia
Provider Communications

Articles Category: State & Federal

Title Publication Category Date

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

March 2023 Anthem Provider News - Virginia Medicaid Mar 1, 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
March 2023 Anthem Provider News - Virginia Medicaid Mar 1, 2023

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
March 2023 Anthem Provider News - Virginia Medicare Mar 1, 2023

Annual planned visits

March 2023 Anthem Provider News - Virginia Medicare Mar 1, 2023

Controlling High Blood Pressure and Submitting Compliant Readings

March 2023 Anthem Provider News - Virginia Medicare Mar 1, 2023

Shared savings and transition care management after inpatient discharges

March 2023 Anthem Provider News - Virginia Medicare Mar 1, 2023

Informational Update Modifier Usage

March 2023 Anthem Provider News - Virginia Medicare Mar 1, 2023

Introducing the Provider Learning Hub

February 2023 Anthem Provider News - Virginia Medicaid Feb 1, 2023

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

February 2023 Anthem Provider News - Virginia Medicare Feb 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
February 2023 Anthem Provider News - Virginia Medicaid Feb 1, 2023

2023 FEP benefit information available online

February 2023 Anthem Provider News - Virginia Federal Employee Plan (FEP) Feb 1, 2023

Introducing the Provider Learning Hub

February 2023 Anthem Provider News - Virginia Medicare Feb 1, 2023

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
February 2023 Anthem Provider News - Virginia Medicare Feb 1, 2023

Engagement with your patient counts

January 2023 Anthem Provider News - Virginia Medicaid Dec 30, 2022

Childhood Immunization Status and Lead Screening in Children for HEDIS

January 2023 Anthem Provider News - Virginia Medicaid Dec 30, 2022

Monkeypox and smallpox vaccines: Product code on claims

January 2023 Anthem Provider News - Virginia Medicaid Dec 30, 2022

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

January 2023 Anthem Provider News - Virginia Medicaid Dec 30, 2022

Submitting prior authorizations digitally through ICR

January 2023 Anthem Provider News - Virginia Medicaid Dec 30, 2022

Implementation of Cardinal Care

January 2023 Anthem Provider News - Virginia Medicaid Dec 30, 2022

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
January 2023 Anthem Provider News - Virginia Medicaid Dec 30, 2022

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
January 2023 Anthem Provider News - Virginia Medicare Dec 30, 2022

Federal Employee Program observation conversion for musculoskeletal cases

January 2023 Anthem Provider News - Virginia Federal Employee Plan (FEP) Dec 30, 2022

Update to the Pregnancy Notification Form

December 2022 Anthem Provider News - Virginia Medicaid Dec 1, 2022

Doula services

December 2022 Anthem Provider News - Virginia Medicaid Dec 1, 2022

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
December 2022 Anthem Provider News - Virginia Medicaid Dec 1, 2022

2023 Medicare Advantage service area and benefit updates

December 2022 Anthem Provider News - Virginia Medicare Dec 1, 2022

Keep up with Medicare news: December 2022

  • Medical drug benefit Clinical Criteria updates
  • Medical Policies and Clinical Utilization Management Guidelines update
December 2022 Anthem Provider News - Virginia Medicare Dec 1, 2022

Personal home helper benefit ending

December 2022 Anthem Provider News - Virginia Medicare Dec 1, 2022

Important information about utilization management

November 2022 Anthem Provider News - Virginia Medicaid Nov 1, 2022

Remote EMR access service for HEDIS

November 2022 Anthem Provider News - Virginia Medicaid Nov 1, 2022

Important information about utilization management

November 2022 Anthem Provider News - Virginia Medicaid Nov 1, 2022

Guidance for coding evaluation and management services for new and established patients

November 2022 Anthem Provider News - Virginia Medicaid Nov 1, 2022

Retraction of policy: Private duty nursing reimbursement

November 2022 Anthem Provider News - Virginia Medicaid Nov 1, 2022

Keep up with Medicaid news: November 2022

  • Prior authorization requirement changes effective November 1, 2022
  • Medical drug benefit Clinical Criteria updates
November 2022 Anthem Provider News - Virginia Medicaid Nov 1, 2022

Keep up with Medicare news: November 2022

  • New specialty pharmacy medical step therapy requirements
  • New specialty pharmacy medical step therapy requirements
  • Medical drug benefit Clinical Criteria updates
November 2022 Anthem Provider News - Virginia Medicare Nov 1, 2022

Personalized Match

November 2022 Anthem Provider News - Virginia Medicare Nov 1, 2022

Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

November 2022 Anthem Provider News - Virginia Medicare Nov 1, 2022

Availity Essentials provider chat: A fast, easy way to get your utilization management questions answered for Federal Employee members

October 2022 Anthem Provider News - Virginia Federal Employee Plan (FEP) Oct 1, 2022

Complex Case Management program

October 2022 Anthem Provider News - Virginia Medicaid Oct 1, 2022

Members’ Rights and Responsibilities section

October 2022 Anthem Provider News - Virginia Medicaid Oct 1, 2022

Reimbursement Policy Retraction: Sexually Transmitted Infections Testing – Professional

October 2022 Anthem Provider News - Virginia Medicaid Oct 1, 2022

Monkeypox resources and recommendations for our care providers

October 2022 Anthem Provider News - Virginia Medicaid Oct 1, 2022

Keep up with Medicaid news: October 2022

  • New specialty pharmacy medical step therapy requirements
  • Prior authorization updates for medications billed under the medical benefit – effective December 1, 2022
  • Prior authorization updates for medications billed under the medical benefit – effective November 1, 2022
  • Private duty nursing reimbursement
  • Change to DME canes, crutches, and walkers benefit limits
  • Change to DME traction equipment
October 2022 Anthem Provider News - Virginia Medicaid Oct 1, 2022

Medicare telehealth services during the Coronavirus (COVID-19) public health emergency FAQ

October 2022 Anthem Provider News - Virginia Medicare Oct 1, 2022

Courtesy notification of specialty pharmacy medical step therapy updates

October 2022 Anthem Provider News - Virginia Medicare Oct 1, 2022

Reimbursement policy retraction: Sexually transmitted infections testing - professional

October 2022 Anthem Provider News - Virginia Medicare Oct 1, 2022

Keep up with Medicare news: October 2022

  • Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
  • Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list – J3490, J3590 and J3299
  • Consultation codes
October 2022 Anthem Provider News - Virginia Medicare Oct 1, 2022

OBRA 93 claim filing for Federal Employee Program

September 2022 Anthem Provider News - Virginia Federal Employee Plan (FEP) Sep 1, 2022

Reimbursement policy update - Modifiers 25 and 57: Evaluation and Management with Global Procedures

September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

Enhancing claims attachment processes through digital applications

September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

New specialty pharmacy medical step therapy requirements

September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

Provider Services Solution enrollment for MCO-only providers

September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

Help your pregnant patients quit smoking

September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

Clinical Laboratory Improvement Amendments

September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

Alcohol use disorders linked to chronic diseases

September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

Keep up with Medicaid news: September 2022

  • Clinical Criteria updates
  • Updates for medication codes billed under the medical benefit
  • Nursing facility admissions and LTSS screenings
  • July 2022 HCBS rate increase notice
September 2022 Anthem Provider News - Virginia Medicaid Sep 1, 2022

Prior authorization requirement changes effective December 1, 2022

September 2022 Anthem Provider News - Virginia Medicare Sep 1, 2022

Reimbursement policy update - Modifiers 25 and 57: Evaluation and Management with Global Procedures

September 2022 Anthem Provider News - Virginia Medicare Sep 1, 2022

Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

September 2022 Anthem Provider News - Virginia Medicare Sep 1, 2022

Reminder: AIM prior authorization phone number change for Medicare

September 2022 Anthem Provider News - Virginia Medicare Sep 1, 2022

Enhancing claims attachment processes through digital applications

September 2022 Anthem Provider News - Virginia Medicare Sep 1, 2022

Keep up with Medicare news: September 2022

  • Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
  • Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ
September 2022 Anthem Provider News - Virginia Medicare Sep 1, 2022

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

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Using screening, brief intervention, and referral to treatment to address opioid and substance use disorders

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

The cost of alcohol use disorder

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Prior authorization requirement changes updated effective November 1, 2022

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Chlamydia screening

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Billing taxonomy code requirements

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Service facilitation visit authorization and limit reminder

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Treatment involving prescription of opioids

August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Keep up with Medicaid news: August 2022

  • One-time COVID-19 Support Payment for Attendant/Aides
August 2022 Anthem Provider News - Virginia Medicaid Aug 1, 2022

Keep up with Medicare news: August 2022

  • MCG care guidelines 26th edition
August 2022 Anthem Provider News - Virginia Medicare Aug 1, 2022

Radiology prior authorization review transitioned to AIM; prior authorization required

July 2022 Anthem Provider News - Virginia Federal Employee Plan (FEP) Jul 1, 2022

Prior authorization requirement changes effective August 1, 2022

July 2022 Anthem Provider News - Virginia Medicaid Jul 1, 2022

MCG care guidelines 26th edition

July 2022 Anthem Provider News - Virginia Medicaid Jul 1, 2022

Antibiotic dispensing guidelines

July 2022 Anthem Provider News - Virginia Medicaid Jul 1, 2022

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

July 2022 Anthem Provider News - Virginia Medicaid Jul 1, 2022

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

July 2022 Anthem Provider News - Virginia Medicaid Jul 1, 2022

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
July 2022 Anthem Provider News - Virginia Medicaid Jul 1, 2022

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

July 2022 Anthem Provider News - Virginia Medicare Jul 1, 2022

Cancer Care Navigator

July 2022 Anthem Provider News - Virginia Medicare Jul 1, 2022

Keep up with Medicare news: July 2022

  • New specialty pharmacy medical step therapy requirements
July 2022 Anthem Provider News - Virginia Medicare Jul 1, 2022

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

June 2022 Anthem Provider News - Virginia Federal Employee Plan (FEP) Jun 1, 2022

Provider notice for COVID-19 testing

June 2022 Anthem Provider News - Virginia Medicaid Jun 1, 2022

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

June 2022 Anthem Provider News - Virginia Medicaid Jun 1, 2022

Medical drug benefit Clinical Criteria updates

June 2022 Anthem Provider News - Virginia Medicaid Jun 1, 2022

Medical Policies and Clinical Utilization Management Guidelines update

June 2022 Anthem Provider News - Virginia Medicaid Jun 1, 2022

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
June 2022 Anthem Provider News - Virginia Medicaid Jun 1, 2022

Provider notice for COVID-19 testing

June 2022 Anthem Provider News - Virginia Medicare Jun 1, 2022

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

June 2022 Anthem Provider News - Virginia Medicare Jun 1, 2022

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

June 2022 Anthem Provider News - Virginia Medicare Jun 1, 2022

Medical drug benefit Clinical Criteria updates

June 2022 Anthem Provider News - Virginia Medicare Jun 1, 2022

Medical Policies and Clinical Utilization Management Guidelines update

June 2022 Anthem Provider News - Virginia Medicare Jun 1, 2022

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
June 2022 Anthem Provider News - Virginia Medicare Jun 1, 2022

Federal Employee Program® AIM radiology prior authorization review reminder

May 2022 Anthem Provider News - Virginia Federal Employee Plan (FEP) May 1, 2022

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

May 2022 Anthem Provider News - Virginia Federal Employee Plan (FEP) May 1, 2022

Join us for a FEP® Quality Learning Program live webinar

Everything you need to know about using CPT II Codes
May 2022 Anthem Provider News - Virginia Federal Employee Plan (FEP) May 1, 2022

Screening for alcohol use disorder in high-prevalence demographics

May 2022 Anthem Provider News - Virginia Medicaid May 1, 2022

Personal care services prior authorization change

May 2022 Anthem Provider News - Virginia Medicaid May 1, 2022

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
May 2022 Anthem Provider News - Virginia Medicaid May 1, 2022
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