Tagged with Anthem
Anthem – Information for Care Providers about COVID-19
Anthem Blue Cross and Anthem Blue Shield (Anthem) has developed a list of frequently asked questions regarding administrative processes and recent changes related to COVID-19.
Anthem Outpatient Facility Edit Implementation
Effective April 26, Anthem Blue Cross Blue Shield (Anthem) will make changes to its outpatient facility edits for revenue codes, CPT® codes, HCPCS and modifiers. These edits will include changes to appropriate use of various code combinations, such as, procedure code to revenue code, HCPCS to revenue code, type of bill to procedure code, type of bill to HCPCS code, procedure code to modifier, and HCPCS to modifier.
Anthem CT Posts Advanced Imaging Clinical Appropriateness Guideline Updates
Anthem Blue Cross and Blue Shield (Anthem) of Connecticut (CT) released certain updates to its Vascular Imaging Clinical Appropriateness Guidelines which includes new and updated language for indication of asymptomatic enlargement by imaging and clarifying surveillance intervals for stable aneurysms.
Anthem Ohio Clinical Laboratory Improvements Amendments
Beginning May 1, claims that are submitted to Anthem Blue Cross and Blue Shield (Anthem) of Ohio for laboratory services subject to the Clinical Laboratory Improvement Amendments (CLIA) 1988 federal statute and regulations will require additional information to be considered for payment.
Anthem CT Outpatient Facility Edit Implementation
Beginning with claims processed on and after April 26, 2020, Anthem Connecticut will be enhancing its outpatient facility edits for revenue codes, Current Procedural Terminology (CPT®) codes, Healthcare Common Procedure Coding System (HCPCS) and modifiers.
Anthem Blue Cross Blue Shield Clinical, Medical, and Coding Updates
Anthem BCBS has posted its recent Clinical, Medical, and Coding Updates, including revisions to Gene Therapy for Spinal Muscular Atrophy guidelines and changes to Positron Emission Tomography (PET) guidelines.
Anthem Connecticut Introduces New Prior Auth Pass Program
Anthem is introducing a new program to reduce the administrative burden associated with current prior authorization (PA) processes for providers who are contracted with Anthem in Connecticut. The Prior Auth Pass Program allows providers who meet program requirements to waive prior authorization for select outpatient medical procedures that generally have high rates of PA requests and approvals.
Anthem Posts Bundled Services and Frequency Editing Reimbursement Policies Updates
Beginning with dates of service November 1, Anthem will implement updates Bundled Services and Supplies and Frequency Editing reimbursement policies.
Anthem Medical Non-Oncology Specialty Drug Review Changes
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.
Anthem Announces Fee Schedule Changes
Anthem Blue Cross and Blue Shield (Anthem) recently notified members of the upcoming changes to its Anthem Plan Fee Schedules, scheduled to take place July 1.
Anthem BCBS Professional Bundled Services and Supplies Update
Anthem has released an update regarding the coding of bundled services for continuous intraoperative neurophysiology monitoring, from outside the operating room.
New York – Anthem Reimbursement Policy Updates
Anthem has posted several reimbursement policy updates, including updates to its Rule of Eight” Reporting Guidelines, system updates for 2019, and updates to policy for Modifier 69.
Wisconsin – Anthem Medical Policies and Clinical UM Guidelines Update
Anthem Wisconsin has updated certain medical policies and clinical utilization management (UM) guidelines to support clinical coding edits.
Anthem – Enhanced Automated Claim Edits
Anthem is updating its editing systems to automate edits supported by correct coding guidelines, as documented in industry sources such as CPT®, HCPCS Level II, and ICD-10. Anthem states the enhanced editing automation will promote faster claim processing and reduce follow-up audits and/or record requests for claims not consistent with correct coding guidelines.
Anthem BCBS Professional Reimbursement Updates
Anthem Blue Cross Blue Shield (BCBS) posted professional reimbursement updates for its policy for once per lifetime procedures bundled and services and supplies.
Anthem BCBS Connecticut Reimbursement Policies Updates
Anthem BCBS Connecticut has updated several of its reimbursement policies, including OBGYN policies, and language changes to professional reimbursement policies.
Anthem BCBS Medical Policy and Clinical Guideline Updates
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.
Anthem Blue Cross and Blue Shield Virginia Coverage and Clinical Guideline Update
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 Withdrawal of Modifier 25 Policy
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.
Wisconsin – Anthem Expands BadgerCare Plus, SSI Plans to Seven Additional Counties
As of January 1st, Anthem expanded its BadgerCare Plus and Medicaid Supplemental Security Income (SSI) plans to seven counties in Wisconsin.