Virginia
Provider Communications

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

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

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

Urinary tract infection toolkits are on the way

It is CAHPS survey time

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

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

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

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

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

Keep up with Medicaid news - September 2021

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

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

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

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

Please provide this information to your patients: Enrollment period for Anthem HealthKeepers Plus in Tidewater area is open through April 30, 2021

Keep up with Medicaid news

Access to more claim denial information is now self-service

MCG Care Guidelines 24th edition customization

New: Provider manual now available

Coding spotlight: Overview of the 2021 evaluation and management changes

Cystic fibrosis procedure codes 81220 to 81224 update

Keep up with Medicaid news

DMAS 80 notifications: Update to fax number

CAHPS® survey

HEDIS® measurement year 2020: Medicaid summary of changes from NCQA

Interpretation services

Medical drug benefit Clinical Criteria updates

Availity Portal eligibility and benefits provides both additional benefit notes and digital member ID Cards

Keep up with Medicaid news

Updates to AIM Clinical Appropriateness Guidelines for Advanced Imaging

FDA approvals and expedited pathways used: New molecular entities (NMEs)

Medical drug benefit Clinical Criteria updates

Coding spotlight: HEDIS MY 2021

Disease Management/Population Health program

New state legislation prompts changes in reimbursement of services during credential process: Medicaid clarification

Discharge planning

Keep up with Medicaid news

CAHPS education for providers