Anthem New Musculoskeletal and Pain Management Solution for Select National ASO Accounts

January 2020 ~

Anthem Blue Cross Blue Shield (BCBS) has announced that the insurer will utilize a new, comprehensive Musculoskeletal and Pain Management Solution (MSK) to review certain spine and joint surgeries/procedures, and interventional pain services against clinical appropriateness criteria to help ensure that care aligns with established evidence-based medicine.

Transition Period

According to the announcement from Anthem BCBS, MSK pose substantial challenges for employers as costs rise, the population ages and physician practice patterns vary widely. To help ensure continuity of care, Anthem BCBS will have a 90 day transition of care for members in active treatment for pain management or for members who have received prior approval through the Anthem precertification.

Providers do not need to obtain authorization through AIM portal for services already in progress or where prior authorization has been obtained with Anthem.

Source(s): January 2020 Anthem Maine Provider News;