Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- June 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 - June 2019*
• New Clinical Guideline: Inpatient Inter-Facility Transfers effective September 1, 2019*

 

Reimbursement Policies

• New Reimbursement Policy: Ambulance Transportation – Professional*
• Reimbursement Policy Update: Frequency Editing – Professional*
• Reimbursement Policy Update: Clinical Validation – Professional [KY only]*

 

Pharmacy Updates

• Anthem expands specialty pharmacy prior authorization list*
• Anthem announces changes in medical non-oncology specialty drug reviews effective June 15, 2019

 

Other Important Updates

• AIM programs may require additional prior authorization documentation
• Medicare and Medicaid News