Virginia
Provider Communications

Articles Category: State & Federal / Medicaid

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

Introducing the Provider Learning Hub

February 2023 Anthem Provider News - Virginia Medicaid 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

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

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

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

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

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

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

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

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

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

The Anthem, Inc. name is changing

April 2022 Anthem Provider News - Virginia Medicaid Apr 1, 2022

Claims reprocessing update for home- and community-based services

April 2022 Anthem Provider News - Virginia Medicaid Apr 1, 2022

Reminder: Provider orientations are available

April 2022 Anthem Provider News - Virginia Medicaid Apr 1, 2022

Disease Management/Population Health program

April 2022 Anthem Provider News - Virginia Medicaid Apr 1, 2022

Clinical Criteria updates

April 2022 Anthem Provider News - Virginia Medicaid Apr 1, 2022

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
April 2022 Anthem Provider News - Virginia Medicaid Apr 1, 2022

Urinary tract infection toolkits are on the way

March 2022 Anthem Provider News - Virginia Medicaid Mar 1, 2022

It is CAHPS survey time

March 2022 Anthem Provider News - Virginia Medicaid Mar 1, 2022

Notice of Regulatory Amendment related to Medicaid participating providers and facilities

February 2022 Anthem Provider News - Virginia Medicaid Feb 1, 2022

Reminder: Provider orientations are available

February 2022 Anthem Provider News - Virginia Medicaid Feb 1, 2022

The Behavioral Health Areas of Expertise Profile improves the referral process

February 2022 Anthem Provider News - Virginia Medicaid Feb 1, 2022

Get faster payments with electronic funds transfer

February 2022 Anthem Provider News - Virginia Medicaid Feb 1, 2022

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
February 2022 Anthem Provider News - Virginia Medicaid Feb 1, 2022

Botox® update for Anthem HealthKeepers Plus members

January 2022 Anthem Provider News - Virginia Medicaid Jan 1, 2022

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

January 2022 Anthem Provider News - Virginia Medicaid Jan 1, 2022

2021 CAHPS Survey results

January 2022 Anthem Provider News - Virginia Medicaid Jan 1, 2022

Submitting prior authorizations is getting easier

January 2022 Anthem Provider News - Virginia Medicaid Jan 1, 2022

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
January 2022 Anthem Provider News - Virginia Medicaid Jan 1, 2022

Reimbursement policy update: Drug Screen Testing

December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

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

December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

Healthy Rewards reminder for providers

December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

Medical Policies and Clinical Utilization Management Guidelines update

December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

Change to durable medical equipment wheelchair benefit limits

December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

Non-payment remittance advice enhancements

December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

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
December 2021 Anthem Provider News - Virginia Medicaid Dec 1, 2021

Electronic data interchange process

November 2021 Anthem Provider News - Virginia Medicaid Nov 1, 2021

Clinical Criteria updates

November 2021 Anthem Provider News - Virginia Medicaid Nov 1, 2021

Unspecified diagnosis reminder

November 2021 Anthem Provider News - Virginia Medicaid Nov 1, 2021

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

November 2021 Anthem Provider News - Virginia Medicaid Nov 1, 2021

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
November 2021 Anthem Provider News - Virginia Medicaid Nov 1, 2021

Diabetes testing and screening HEDIS measures

October 2021 Anthem Provider News - Virginia Medicaid Oct 1, 2021

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

October 2021 Anthem Provider News - Virginia Medicaid Oct 1, 2021

Prior authorization updates for specialty pharmacy

October 2021 Anthem Provider News - Virginia Medicaid Oct 1, 2021

Prior authorization updates for specialty pharmacy

October 2021 Anthem Provider News - Virginia Medicaid Oct 1, 2021

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
October 2021 Anthem Provider News - Virginia Medicaid Oct 1, 2021

Keep up with Medicaid news - September 2021

View these Medicaid articles:
  • Clinical Criteria updates notification 
  • New specialty pharmacy medical step therapy requirements:  Iron Infusion Step Therapy
  • Prior authorization required for specialty pharmacy drugs:  Iron Infusion Prior Authorization Update

 

September 2021 Anthem Provider News - Virginia Medicaid Sep 1, 2021

Adding 87081 to Physician Office Lab list

August 2021 Anthem Provider News - Virginia Medicaid Aug 1, 2021

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

August 2021 Anthem Provider News - Virginia Medicaid Aug 1, 2021

Closing gaps in care through telehealth

August 2021 Anthem Provider News - Virginia Medicaid Aug 1, 2021

Keep up with Medicaid news

August 2021 Anthem Provider News - Virginia Medicaid Aug 1, 2021

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

July 2021 Anthem Provider News - Virginia Medicaid Jul 1, 2021

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

July 2021 Anthem Provider News - Virginia Medicaid Jul 1, 2021

Coding spotlight: Mental disorders in childhood

July 2021 Anthem Provider News - Virginia Medicaid Jul 1, 2021
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