Virginia
Provider Communications

E-visits

Authorizations for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services for consumers with individual, group retiree solutions (GRS), and dual-eligible plans from Medicare Advantage

Keep up with Medicare news - April 2023

• Clinical Criteria updates
• Clinical Criteria updates
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• Blue Cross and Blue Shield expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements
• Genetic testing CPT code list update for Carelon Medical Benefits Management (formerly AIM Specialty Health)

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

Annual planned visits

Controlling High Blood Pressure and Submitting Compliant Readings

Informational Update Modifier Usage

Shared savings and transition care management after inpatient discharges

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

Introducing the Provider Learning Hub

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

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

2023 Medicare Advantage service area and benefit updates

Keep up with Medicare news: December 2022

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

Personal home helper benefit ending

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

Personalized Match

Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

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

Courtesy notification of specialty pharmacy medical step therapy updates

Reimbursement policy retraction: Sexually transmitted infections testing - professional

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

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

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

Keep up with Medicare news: August 2022

• MCG care guidelines 26^th edition

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

Cancer Care Navigator

Keep up with Medicare news: July 2022

• New specialty pharmacy medical step therapy requirements

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

Medical Policies and Clinical Utilization Management Guidelines update

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

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

The Anthem, Inc. name is changing

Model of Care required training

The impact of listening

Clinical Criteria updates

Implementation update for the NYC Medicare Advantage Plus plan, an alliance between Empire BlueCross BlueShield and EmblemHealth

Keep up with Medicare news: April 2022

• Medical Policies and Clinical Utilization Management Guidelines update
• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• AIM Specialty Health Outpatient Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines updates

Implementation update for the NYC Medicare Advantage Plus plan, an alliance between Empire BlueCross BlueShield and EmblemHealth

Annual wellness visits for Medicare Advantage members

Pharmacy newsletter

Clinical Criteria updates

Prior authorization requirement changes effective June 1, 2022

Keep up with Medicare news: March 2022

• Medical step therapy updates

Get faster payments with electronic funds transfer

Keep up with Medicare news: February 2022

• NYC Medicare Advantage Plus update
• Cancer Care Navigator

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

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

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.

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

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

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

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

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

Maximizing efficient, high quality COVID-19 screenings

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