Anthem Medical Non-Oncology Specialty Drug Review Changes

June 2019 ~

As seen in its latest provider newsletter, Anthem Blue Cross Blue Shield (Anthem) continues to streamline its medical specialty drug reviews by transitioning another drug review process from AIM to Anthem’s medical specialty drug review team.

Beginning June 15, for all requests, regardless of service date, providers will need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team.

Providers can submit new prior authorization: request by contacting Anthem’s medical specialty drug review team:

  • by phone at 833-293-0659 or
  • by fax at 888-223-0550 or
  • online access at availity.com available 24/7

All inquiries about an existing request (initially submitted to AIM or Anthem), peer-to-peer review, or reconsideration will be managed by Anthem’s medical specialty drug review team.

The following policies and services will remain the same:

  • AIM will continue to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
  • Medical policies and clinical guidelines for non-drug specialty topics will continue to reside at the Office of Medical Policy & Technology Assessment (OMPTA) homepage.
  • Post service clinical coverage reviews and grievance and appeals process and teams will not change.

A summary of the medical specialty drug changes from UHC can be seen below.

 

Source(s): Anthem Provider News; June 2019 Anthem Connecticut Provider Newsletter;

 

 

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