Provider Communications & Updates

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Anthem Network Updates

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Current Issue

Provider Bulletins

 2014
Administrative Denial Notification
Authorization Notification July 2014
Pharmacy Formulary Change Notice
Anthem Medicaid Name Change Announcement
Open Enrollment
Pharmacy Formulary Change Notice Effective March 1, 2015
KYKY_CAID_PU_Admin_Denial_Notification.pdf
 2015
Availity FAQs
Updated Confidentiality of Records Policy
CMHC Medicaid Billing Guidance Second Edition
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
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
Precertification for Entyvio and Cyramza
Update: Home therapy precertification requirements
Cervical Length Screening Guidelines
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
Quarterly pharmacy formulary change notice effective May 1, 2016
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
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
Quarterly pharmacy formulary change notice effective October 1, 2016
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
Authorization requirement changes for behavioral health
Process change for adding or updating the NPI/taxonomy code
Importance of Behavioral Health Collaboration
 2017
Modifier 57: Decision for Surgery
Quarterly pharmacy formulary change notice effective February 1, 2017
Pharmacy and Therapeutics Committee Meeting Minutes - December 7, 2016
Quarterly pharmacy formulary change notice effective March 1, 2017
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
Quarterly pharmacy formulary change notice effective May 1, 2017
Medical Policy Update Notification
Pharmacy and Therapeutics Committee Meeting Minutes - February 28, 2017
Authorization rule additions effective May 1, 2017
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
Beginning in April: Access Patient360 directly through the Availity Web Portal
Quarterly pharmacy formulary change notice effective August 1, 2017
Quarterly pharmacy formulary change notice effective July 1, 2017
Wheelchair component or accessory, not otherwise specified to require prior authorization
Q1 2017 MPTAC Notification
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
New review process for not otherwise classified drug codes
Substance use disorders in pregnancy and neonatal abstinence syndrome
Mavyret pharmacy formulary change notice effective November 1, 2017
Pharmacy and Therapeutics Advisory Committee Meeting - October 25, 2017
Q2 Medical Policies and Clinical Utilization Management Guidelines update
Physical and behavioral health: collaborating care
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
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
ICS Pharmacy Formulary Change Notice
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
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
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
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
Multiple Radiology Payment Reduction
Reimbursement for early elective deliveries at 37 and 38 weeks’ gestation that do not meet medical necessity criteria
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
Correction: Cervical length measurement by transvaginal ultrasound
Clinical Criteria Updates - Posted 3/6/2019
Prenatal Ultrasound Policy/ICD-10 Update
Medical necessity review for appropriate level of care
Denial of claims billed with noncovered codes
Quarterly pharmacy formulary change notice effective May 1, 2019
Prior authorization requirements for drug codes
Prior authorization requirements for Subcutaneous Implantable Defibrillator system
Buprenorphine prior authorization
New Specialty Pharmacy Medical Step Therapy Requirements
Changes to prior authorization requirements for drug codes effective June 1, 2019
2019 Utilization Management Affirmative Statement concerning utilization management decisions
Quarterly pharmacy formulary change notice part II effective May 1, 2019
November 2018 Medical Policies and Clinical Utilization Management Guidelines Update
Medicaid Enrollment Denial
Notification of change regarding noninvasive ventilator use
Notification of change in hours of observation status
Provider File Load Error
Health Crowd Provider Education
Electronic claim payment appeal
Substance Use Disorder (SUD) 1115 Waiver Update
Prepayment clinical validation review process
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice effective August 1, 2019
Update to Kentucky Medicaid durable medical equipment fee schedule reimbursement
2019 Provider Satisfaction Survey: We need your help!
Unspecified diagnosis code update
Clinical Criteria Web Posting Q2 2019
Clinical Laboratory Improvement Amendments
InterQual 2019 update
Provider payment schedule updates
Pharmacy benefit manager change to IngenioRx
Clinical Criteria web posting Q1 2019
New pregnancy notification process using the Availity Portal Benefit Look-Up Tool
Screening Brief Intervention and Referral to Treatment (SBIRT) Flier
Prior authorization requirements changes effective November 1, 2019
Quarterly pharmacy formulary change notice effective November 1, 2019
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Criteria Web Posting July 2019
340B Billing guidance update
Launch of the Kentucky Perinatal Quality Collaborative
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Radiology and cardiology benefits management
Semi Annual Cost of Care Review
Changes to precertification guidelines
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
Medically directed anesthesia services
New clinical guideline: pneumatic compression devices, effective December 11, 2019
Clinical Criteria Web Posting August 2019
Precertification requirement change
August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Improving the Patient Experience – CME
InterQual 2019.1 update
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update
 2020
Anthem Blue Cross and Blue Shield Medicaid Provider Manual
Concurrent Review Fax Form
Initial Review Fax Form
Emergency Services: Nonparticipating Providers and Facilities
Global Surgical Package for Professional Providers
Locum Tenens Physicians/Fee-for-Time Compensation
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)
Portable/Mobile/Handheld Radiology Services
Requirements for Documentation of Proof of Timely Filing
Prosthetic and Orthotic Devices
Reimbursement for Reduced and Discontinued Services
Robotic Assisted Surgery
Scope of Practice
Unlisted, Unspecified or Miscellaneous Codes
DRG Inpatient Facility Transfers
Professional Anesthesia Services
PreventiveH ealth Guidelines
Facility Take-Home DME and Medical Supplies
Durable Medical Equipment (Rent to Purchase)
Reimbursement for Maximum Units Per Day
Pharmacy Prior Authorization Form
Corrected Claims
Healthy Rewards Program
Cultural Competency Training
Provider Orientation Workshop Registration
Pharmacy and Therapeutics Advisory Committee 2020 Meeting Dates
Quarterly pharmacy formulary change notice effective February 1, 2020
New! Provider manual now available
BH Interactive Care Reviewer Training Presentation
New specialty pharmacy medical step therapy HAE requirements
Urine drug testing policy
Incorrect Claims Processing Alert
Coding tip for psychological and neuropsychological testing
Provider Solutions Hospital Assignments
Provider Solutions territory realignment
Provider Solutions Regions
Clinical Criteria Web Posting September 2019
Patient360 and Availity Demo
Prior authorization requirements: new 2020 codes for coverage and precertification
Provider data validation survey
Clinical Criteria Web Posting November 2019
Clinical Criteria Web Posting December 2019
COVID-19 Guidance (March 23, 2020)
Anthem Blue Cross and Blue Shield (Anthem) COVID-19 telehealth webinar
Kentucky Health Information Exchange Grant Application
Acquisition of Beacon Health Options
Prior authorization guidance during COVID-19 crisis
New value-added benefit: LiveHealth Online effective April 1, 2020
Federal resources available for health care providers and employers in the federal CARES Act
Copays waived
2020 affirmative statement concerning utilization management decisions
Quarterly pharmacy formulary change notice effective May 1, 2020
Modifier use reminders
Clinical Criteria Web Posting February 2020
Appointment availability and after-hours access requirements
Electronic submission is preferred method for requesting pharmacy prior authorization
Department of Health and Human Services announces additional distributions from the Provider Relief Fund to eligible Medicaid and Children’s Health Insurance Program providers (June 12, 2020)
Associates Performing Utilization Reviews
Emergency Services
Prohibiting the Use of Financial Incentives
Transplant Approval Policy
Utilization Management- Clinicians Responsibilities
Utilization Management- Medicaid Delegation and Oversight
InterQual 2020 update
Revised Medicaid urine drug testing policy
Notification of Pregnancy
Provider data update
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
Provider data validation survey
Quarterly pharmacy formulary change notice effective August 1, 2020
Medicaid & CHIP Provider Relief Fund Update (July 22, 2020)
Quarterly pharmacy formulary change notice effective August 1, 2020
New behavioral health discharge call-in line
August is Immunization Awareness Month
Clinical Criteria Web Posting March 2020
New Baby, New Life Provider Booklet
Provider data validation survey
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