Tagged with Anthem
Ohio – New Legislation Impacts Electronic Prior-Authorization Requests
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.
Indiana Medicaid Medical Policy Updates
Anthem BCBS of Indiana has issued notice of medical policy revisions approved by the Medical Policy and Technology Assessment Committee (MPTAC).
New Hampshire Anthem BSBS New Musculoskeletal Program
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.
Anthem BCBC Provider Payment Schedule Update
Starting in 2018, more claim payments and remittance advice issued to Anthem providers will be made on a weekly basis.
Anthem EDI Edit for 837 Professional Independent Lab Claims
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.
Anthem Integrated Medical and Behavioral Healthcare Reimbursement Policy Update
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 BCBS – Medical Policy and Clinical Guideline Updates
Anthem Blue Cross and Blue Shield released updated medical policies and clinical guidelines to be implemented on November 1, 2017 in certain states.
ME – State Insurance Companies Want Double-Digit Rate Increases For 2018
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.
Anthem Updates Assistant Surgeon Policy and Code List
Anthem has posted its updated Assistant Surgeon policy and code list to reflect CPT® and Healthcare Common Procedure Coding System (HCPCS Level II) coding changes for 2017 as well as updates based on American College of Surgeons (ACS) and CMS information.
OH – Anthem BCBS to Exit Ohio ACA in 2018
Anthem Blue Cross Blue Shield has announced it will leave the Affordable Care Act market in Ohio in 2018 and will reduce its footprint in the state to one off-exchange product in one county.
NH – Minuteman Health ask for 30% Rate Increase
The second-largest insurer in the New Hampshire Affordable Care Act (ACA) market has requested average rate hikes of 30% for 2018, citing Medicaid expansion and federally imposed risk adjustments as the cause for the request.
Anthem Leaves Ohio ACA Exchange
Anthem has announced that it will pull out of Ohio’s Affordable Care Act (ACA) individual insurance marketplace for the 2018 plan year.
CT – State Insurers Request Rate Increases on Individual and Group Plans
Health insurers in Connecticut have submitted health insurance rate request individual and small group plans in 2018. A total of 10 health insurance companies have made 14 filings on individual and small group plans that provide coverage to approximately 270,000 people in the state. The average rate requests range from 3.6% to 33.8%.
Anthem Ends Cigna Merger Agreement
Anthem recently announced that it will stop pursuing Cigna. The insurer claims Cigna sabotaged the deal and states it will not pay the agreed-upon breakup fee of $1.8 billion.
Aetna to Exit all ACA Insurance Marketplaces in 2018
Aetna has announced plans completely withdraw from the ACA insurance exchanges for 2018, citing financial losses as the deciding factor, specifically its individual commercial products lost nearly $700 million between 2014 and 2016 and could lose another $200 million this year.
