Tagged with Anthem
Anthem’s behavioral health medical policies and clinical guidelines currently in place for reviewing of behavioral health services, will be replaced by the MCG Care Guidelines 22nd edition Behavioral Health guidelines.
Effective July 1, Anthem will implement processing updates for service claims under certain programs, including radiation oncology and cardiology services, which require precertification through AIM Specialty Health® (AIM).
Anthem Blue Cross Blue Shield (Anthem BCBS) will soon implement changes to its clinical payment and coding policy for several services and procedures.
Anthem Blue Cross Blue Shield (BCBS) will update its facility policy for inpatient stay claims reimbursed at a percent of charge with billed charges above $40k will require additional documentation in certain states, beginning with dates of service on and after July 13th.
Anthem Blue Cross Blue Shield (BCBS) published a notice stating that effective with dates of service on and after July 1st a separate company, AIM Specialty Health (AIM), will apply AIM’s Radiation Oncology Clinical Appropriateness Guidelines to precertification requests for certain services.
As of July 1, Anthem Blue Cross and Blue Shield of Wisconsin (BCBSWI) will require unspecified diagnosis codes to only be used when an established diagnosis code does not exist to describe the diagnosis. Reimbursement will be based on review of the unspecified diagnosis code on an individual claim basis.
Anthem Blue Cross Blue Shield of New Hampshire (BCBSNH) has released updates to its current reimbursement policy for E&M services and related modifiers 25 and 57 professional reimbursement, facility claims requiring additional documentation policy, as well as its pharmaceutical waste facility reimbursement policy.
Anthem Blue Cross Blue Shield of Indiana (BCBSIN) Medicaid has released updates to certain coding and medical policies, including the use of unspecified diagnosis codes and prior authorization prior authorization for elotuzumab.
Following a review of its current medical polices, Anthem BlueCross BlueShield (BCBS) has released an updated list of medical policies which will be converted to clinical guidelines, effective May 1.
Effective May 1, Anthem Blue Cross and Blue Shield in Virginia (BCBS VA) will implement new and revised coverage guidelines approved at the most recent quarterly Medical Policy and Technology Assessment Committee meeting.
Anthem Blue Cross and Blue Shield (BCBS) has published a notice informing health care professionals and policyholders that the insurer will no longer proceed with the reimbursement policy impacting physician use of payment Modifier 25.
As of January 1st, Anthem expanded its BadgerCare Plus and Medicaid Supplemental Security Income (SSI) plans to seven counties in Wisconsin.
As of January 1st, Ohio Senate Bill 129 (House Bill 505) now requires insurers to implement faster turn-around times for reviews of prior-authorizations (PA) that are submitted electronically.
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).
Effective March 1, 2018, AIM Specialty Health (AIM) will perform medical necessity review of certain elective surgeries of the spine and joints, as well as interventional pain treatment for fully insured Anthem BSBS NH members.
Starting in 2018, more claim payments and remittance advice issued to Anthem providers will be made on a weekly basis.
Effective December 8, Anthem EDI began implementation of a new edit related to independent laboratory claims which reduces the processing time and manual intervention for lab claims.
For dates of service on or after December 1, 2017, Anthem Blue Cross and Blue Shield (Anthem BCBS) will begin reimbursement for Psychiatric Care Collaborative Management Healthcare Common Procedure Coding System (HCPCS Level II) codes.
Anthem Blue Cross and Blue Shield released updated medical policies and clinical guidelines to be implemented on November 1, 2017 in certain states.
Harvard Pilgrim, Maine Community Health Options, and Anthem Blue Cross Blue Shield are each requesting double-digit rate increases for 2018. The three insurers cite political uncertainty and a higher percentage of unhealthy policyholders as reasons for their requests.