Provider data update
Anthem Blue Cross and Blue Shield Medicaid (Anthem) partners with AIM Specialty Health®* (AIM), a leading specialty benefits management company that provides services for radiology, cardiology, genetic testing, oncology, musculoskeletal, rehabilitation, sleep management, and additional specialty areas. Partnerships like this require that Anthem’s provider demographic information (group or practice name, additional providers added to the group/practice, location) is current and accurate to eliminate provider and member abrasion.
New specialty pharmacy medical step therapy requirements
Effective for dates of service on and after April 1, 2020, Anthem Blue Cross and Blue Shield
Medicaid will include the specialty pharmacy drugs and corresponding codes from current
clinical criteria noted below in our medical step therapy precertification review process. Step
therapy review applies upon precertification initiation or renewal in addition to the current
medical necessity review (as is done currently).
Availity Provider FAQ and Availity Notification
Starting March 9, 2020, Anthem Blue Cross and Blue Shield Medicaid will launch the use of Availity’s Medical Attachment functionality for electronic communications. This new functionality allows providers to upload medical records and itemized bill information electronically instead of through traditional paper communications. This functionality can improve communications for medical record requests and receipt and will not impact the audit program.
Pharmacy benefit manager change to IngenioRx
Effective October 1, 2019, IngenioRx will become the pharmacy benefit manager (PBM) for prescription drugs, home delivery pharmacy and specialty pharmacy for Anthem Blue Cross and Blue Shield Medicaid (Anthem) members.
Pharmacy and Therapeutics Advisory Committee 2020 Meeting Dates
Announcement for Pharmacy and Therapeutics Advisory Committee Meeting Dates Scheduled for 2020