Virginia
Provider Communications

Prior authorization requirement changes effective December 1, 2022

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

Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

Reminder: AIM prior authorization phone number change for Medicare

Keep up with Medicare news: August 2022

• MCG care guidelines 26^th edition

Enhancing claims attachment processes through digital applications

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

Preventing claims denials: Shingles vaccine

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

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Medical drug benefit Clinical Criteria updates

Keep up with Medicare news

Medical drug benefit Clinical Criteria updates

UPDATE: Notice of changes to the AIM musculoskeletal program

2023 Medicare Advantage service area and benefit updates

Keep up with Medicare news

Preferred continuous glucose monitors

Provider Chat: A fast, easy way to get your questions answered

Medical drug benefit Clinical Criteria updates

FDA approvals and expedited pathways used: New molecular entities

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.

Keep up with Medicare news: December 2022

• Medical drug benefit Clinical Criteria updates
• Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Medicare news

2020 Medicare risk adjustment provider training

Medical drug benefit Clinical Criteria updates

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

Medical drug benefit Clinical Criteria updates

Electronic data interchange process

Keep up with Medicare News

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

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

New CMS requirement: Hospitals must use Medicare Outpatient Observation Notice

Medical Policies and Clinical Utilization Management Guidelines update

Reimbursement policy: Modifier 62 Co-Surgeons

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

Keep up with Medicare news

Medical drug Clinical Criteria updates

Prior authorization requirements changes effective November 1, 2019

Update: 2019 risk adjustment provider trainings

Medical Policies and Clinical Utilization Management Guidelines update

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

An update about Anthem’s direct contracting effort for nurse practitioners and physician assistants

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

Aspire Telehealth Palliative Care program: Aspire Health* for Medicare members in need of telephonic palliative care

Volvo Group North American offers Medicare Advantage option

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

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

Medicare preferred continuous glucose monitors

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

Keep up with Medicare news

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

Courtesy notification of specialty pharmacy medical step therapy updates

Update regarding evaluation and management with modifier 25 same day as procedure when a prior E/M for the same or similar service has occurred

Reimbursement policy retraction: Sexually transmitted infections testing - professional

Coming soon: Reimbursement for select HEDIS-related CPT II codes for Medicare Advantage members

Keep up with Medicare news

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

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

Dual Eligible Special Needs Plans: Provider training required

Coming soon: Electronic attachments

Change to 835 ERA for all D-SNP MA members for 2019

Clinical Criteria updates

Introducing the Provider Learning Hub

Clinical criteria updates for specialty pharmacy

Customizations to the 23rd edition of the MCG Care Guidelines

Anthem to contract directly with NPs, PAs in 2019

Changes to PA requirements

Keep up with Medicare news

Pharmacy benefit manager change to IngenioRx

Introducing a new clinical criteria Web page for injectable, infused or implanted drugs covered under the medical benefit

Keep up with Medicare news

Medical drug benefit Clinical Criteria updates effective March 26, 2021

Medical drug benefit Clinical Criteria updates effective April 8, 2021

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

Notify us of telehealth services

Medical drug benefit Clinical Criteria updates

New MCG Care Guidelines 24th edition

Digital transactions cut administrative tasks in half

2020 Medicare risk adjustment provider trainings

2021 Medicare Advantage individual benefits and formularies

Personal home helper benefit ending

AIM Musculoskeletal program expansion

Medicare Advantage Group Retiree member eligibility, alpha prefix FAQ

Keep up with Medicare news

Medical Policies and Clinical Utilization Management Guidelines update

Keep up with Medicare news