Provider Communications & Updates

Newsletters

Anthem Network Updates

2018

Network Update - current edition

2017

2017 Network Updates

2016

2016 Network Updates

2015

December 2015 Network Update

October 2015 Network Update

August 2015 Network Update

June 2015 Network Update

April 2015 Network Update

Provider Bulletins

 2014
Administrative Denial Notification
Authorization Notification July 2014
Newborn Diagnosis-Related Group Policy
Pharmacy Formulary Change Notice
CMS-1500 Form & UB04 Taxonomy Code Requirements
Anthem Medicaid Name Change Announcement
Open Enrollment
Copays Removed from All Medical Services
Fee Schedule Reimbursement
Reminder to submit NDC number and units
Pharmacy Formulary Change Notice Effective March 1, 2015
KYKY_CAID_PU_Admin_Denial_Notification.pdf
 2015
PCP Rate Increase Decommissioning Update
Availity FAQs
Patient360
Updated Confidentiality of Records Policy
Newborn Diagnosis Related Group Policy
EPSDT Referral Codes
CMHC Medicaid Billing Guidance Second Edition
Reimbursement for Professional Vision Services
Provider Relations Territory Map
2015 Issue #1 Reimbursement Policy Bulletin
Member Lock-In Program
Advair Formulary Change Notice Effective July 1, 2015
June Pharmacy and Therapeutics Advisory Committe Meeting and Agenda
ICD-10 Coding Update
Important Notice to Providers registered for ERA
Q2 Clinical Utilization Management Guidelines List​
Kentucky Region Three Expansion
Allergy Treatment: Immunotherapy Reimbursement Policy Update Effective August 1, 2015
CMS, AMA help providers prepare for ICD-10 transition
Precertification for Entyvio and Cyramza
Update: Home therapy precertification requirements
Cervical Length Screening Guidelines
Update: Dental Screening Code D0109
Submitting corrected claims electronically
Pharmacy & Therapeutics Meeting Announcement
Data Management Program Flier
Smoking Cessation Leadership Center webinar series
Quarterly pharmacy formulary change notice effective February 1, 2016
MCG Health, LLC Criteria to Determine Medical Necessity
 2016
Update: Hemophilia drugs require medical necessity reviews effective November 1, 2015
Precertification for knee and hip arthroplasty effective May 1, 2016
Kentucky Pharmacy and Therapeutics Advisory Committee Meeting Decisions - December 16, 2015
Precertification for knee arthroscopy effective April 1, 2016
Important information regarding 17P coverage
Request for to update taxonomy code
Prenatal Ultrasound Policy/ICD-10 Update
Lesser of Application
Update to Attending Provider Billing Requests
Quarterly pharmacy formulary change notice effective May 1, 2016
Reduction in reimbursement to nonparticipating providers
Sanctioned Provider Edits
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
New LARC benefit provider letter
Quarterly pharmacy formulary change notice effective July 1, 2016
Prior authorization requirement for Nulojix effective August 5, 2016
Vaccines for Children Program billing guidelines
Update Taxonomy Code
20th Edition of MCG to determine medical necessity
Medicaid physician fee schedule: place of service codes and pricing
Federal nondiscrimination and accessibility update
Public Health Officials Zika Virus Warning
Update to Sanctioned Provider Edit
2016 Provider Satisfaction Survey Reminder
Coordination of benefits — policy update
Quarterly pharmacy formulary change notice effective October 1, 2016
Provider Relations contact information
QVAR pharmacy formulary change notice effective September 1, 2016
Quarterly pharmacy formulary change notice effective September 1, 2016
Quarterly pharmacy formulary change notice effective November 1, 2016
Diagnosis Related Group version update
Changes to approval notification process
Changes to Chiropractic Services
Authorization requirement changes for behavioral health
Process change for adding or updating the NPI/taxonomy code
Importance of Behavioral Health Collaboration
SBIRT
Reimbursement Limitation for CPT Codes 99214 and 99215
E59 denials — attending taxonomy missing/invalid
 2017
Modifier 57: Decision for Surgery
Modifiers LT and RT: Left Side/Right Side Procedures
Quarterly pharmacy formulary change notice effective February 1, 2017
Pharmacy and Therapeutics Committee Meeting Minutes - December 7, 2016
Physician Fee Schedule - POS Mapping
New place of service code for telehealth
Quarterly pharmacy formulary change notice effective March 1, 2017
BH Treatment Plan Reminder
Chiropractic Services Update
Importance of Behavioral Health Collaboration Brochure
Pharmacy and Therapeutics Advisory Committee Meeting - February 28, 2017
Additional information on ClaimCheck® upgrade to ClaimsXten™
Authorization rule additions and deletions effective April 1, 2017
Interqual guidelines to determine medical necessity
Facility clinic charge reimbursement policy
Adding modifier 52 to the routine anatomic evaluation billing code
IMPORTANT Claims Edits for ORPA Providers
Quarterly pharmacy formulary change notice effective May 1, 2017
Facility Clinic Charge Bulletin
Medical Policy Update Notification
Provider Appeals - Medical Necessity and Payment
Pharmacy and Therapeutics Committee Meeting Minutes - February 28, 2017
Authorization rule additions effective May 1, 2017
Ordering, Referring, Prescribing and Attending Providers Webinar
Claim denial — Z21 provider type
Update to the ClaimsCheck® upgrade to ClaimsXten™
Federally qualified health center claims encounters
Quarterly pharmacy formulary change notice effective May 26, 2017
Alliant Health Solutions collaboration
Member Value-Added Benefit: Free Sports Physicals
Beginning in April: Access Patient360 directly through the Availity Web Portal
Quarterly pharmacy formulary change notice effective August 1, 2017
What does HEDIS mean to you?
Alliant Health Solutions Partnership
Quarterly pharmacy formulary change notice effective July 1, 2017
ORPA Webinar Presentation
Vaccines Added to the Pharmacy Benefit
Wheelchair component or accessory, not otherwise specified to require prior authorization
Q1 2017 MPTAC Notification
Federally qualified health center and rural health center claims encounters
Hemophilia factor injections to require prior authorization
Kentucky Provider Important Contact Information
Vaccines added to the pharmacy benefit
Quarterly pharmacy formulary change notice effective November 1, 2017
Reimbursement for early elective deliveries at 37 and 38 weeks gestation that do not meet medical necessity criteria
New review process for not otherwise classified drug codes
Antibiotic overuse
Substance use disorders in pregnancy and neonatal abstinence syndrome
DRG Outlier Claims Updated
Mavyret pharmacy formulary change notice effective November 1, 2017
Pharmacy and Therapeutics Advisory Committee Meeting - October 25, 2017
Frequently asked questions on Ordering, Referring, Prescribing and Attending edits
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Physical and behavioral health: collaborating care
Medical Policy Update
Q3 Medical Policies and Clinical Utilization Management Guidelines update
Update 2017 Q3 Medical Policy
Medical Policies and Clinical Utilization Management Guidelines update - Q4 2017
 2018
Anthem Blue Cross and Blue Shield Medicaid Provider Manual
Multiple Radiology Payment Reduction
Buprenorphine Products Prior Authorization Form​ Update
New Pharmacy Prior Authorization Fax Number
Quarterly pharmacy formulary change notice effective February 1, 2018
Age limits pharmacy formulary change notice effective February 1, 2018
J codes to require pharmacy prior authorization
Elotuzumab to require prior authorization
Prior Authorization needed for Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant
Medical Policies update
February 24 Treatment of Opioid Disorder Course Flyer
March 10 Treatment of Opioid Disorder Course Flyer
Reimbursement for Early Elective Deliveries
Notice to EMS Providers
ICS Pharmacy Formulary Change Notice
2018 Utilization Management Affirmative Statement
Multiple Radiology Payment Reduction
Update to radiology benefit management
Medicaid Institutions for Mental Diseases Exclusion Rule
Claims billed with modifiers GR, GY, GX and GZ
Participating hospitals: nonpriced codes effective April 15, 2018
Changes to precertification
Billing Guidelines for Transgender Members
Changes to Precertification
Medical Policy update - Hyaluronan Injections
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
ICS pharmacy formulary change notice update: effective April 15, 2018
Prior authorization requirement update for Mylotarg
Zepatier, cough and cold pharmacy formulary change notice effective June 1, 2018
Value Based Payment Notification
Changes to Precertification - Place of Service (POS) 32 Skilled Nursing Facilities (SNF)
Eight injectable drugs will require prior authorization
Physical and behavioral health collaborative care
Prior authorization requirements for drug pemetrexed
Long-Acting Reversible Contraception Update: Effective February 1, 2018
Changes to prior authorization
Quarterly pharmacy formulary change notice effective August 1, 2018
January - 2018 Medical Policies and Clinical Utilization Management Guidelines update
PA requirements for pemetrexed (ALIMTA)
March - 2018 Medical Policies and Clinical Utilization Management Guidelines update
January 2018 Clinical Utilization Management Guidelines
Miscellaneous durable medical equipment billing guidelines
Notification reminder regarding lock-in specialist referrals
Multiple Radiology Payment Reduction Reimbursement Policy Update
Hepatitis A vaccine update
Prior authorization requirements for Cabazitaxel
Prior authorization requirements for Darzalex drug
Mepolizumab and reslizumab
Medical Policies and Clinical Utilization Management Guidelines update - May 2018
Provider data validation survey
Quarterly pharmacy formulary change notice effective October 1, 2018
Reminder: precertification for pain management services
Medicaid member open enrollment
Prior authorization requirements for Somatrem
Rights and responsibilities of Anthem Blue Cross and Blue Shield Medicaid Members
Cervical length measurement by transvaginal ultrasound
Reimbursement Change for Midlevel Practitioners
Taxonomy code billing requirement change for FQHC and RHC Providers
Prenatal formulary change notice effective August 1, 2018
Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants
Prior authorization requirements for Sublocade
Copay updates for specific services
Prior authorization requirements for Interferon beta-1a
Services requiring prior authorization
Prior authorization requirements for Emicizumab-kxwh injection
Durable medical equipment incontinence supplies benefit limit update
CPT Category II Code Reimbursements
 2019
Medicare crossover claims for federally qualified health centers and rural health clinics
July 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice effective February 1, 2019
Introducing a new clinical criteria web page for injectable, infused or implanted drugs covered under the medical benefit
Aspire Health provides palliative care for Medicaid members
Electronic data interchange gateway update
Diabetes Coding Spotlight
Transplant criteria notification
KY HEALTH Webinar Invite