Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- August 2019

Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements starred (*) below.

Medical Policies and Clinical Guidelines

• Medical Policy and Clinical Guideline Updates -- August 2019*
• Anthem customizations to MCG care guidelines 23rd edition*
• Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

Reimbursement Policies

• Reimbursement Policy Update: Bundled Services-Professional*
• Reimbursement Policy Update: Frequency Editing-Professional*

Pharmacy Updates

• Clinical criteria and prior authorization updates for specialty pharmacy are available*
• REMINDER: Changes to the process for Medical Non-Oncology Specialty Drug reviews effective June 15, 2019

Other Important Updates

• Medicare and Medicaid News