Provider Communications & Updates

Newsletters

Anthem Network Updates

2019

Current Issue

2018

Network Update - current edition

2017

2017 Network Updates

2016

2016 Network Updates

2015

December 2015 Provider Newsletter

October 2015 Provider Newsletter

August 2015 Provider Newsletter

June 2015 Provider Newsletter

April 2015 Provider Newsletter

Provider Bulletins

 2014
Provider Bulletin: Sleep Study Management Program
 2015
New Pharmacy Network
Patient360 Information
OrthoNet to Conduct Post-service Prepay Reviews
2015 Issue #1 Reimbursement Policy Bulletin
Postpartum long-acting contraception benefit now available
ICD-10 Coding Update
Important Notice to Providers who are Registered for ERA
Q2 Clinical Utilization Management Guidelines Update​
ICD-10 Update: Providers should register for ICD-10 Claims testing by September 1, 2015
Precertification for Entyvio and Cyramza
Precertification for Part B Drugs Entyvio and Cyramza
Cervical Length Screening Guidelines
Changes to nonemergency transportation partner
PCP ICT Participation
New Patient Payment Process
Q3 Clinical Utilization Management Guidelines Update​
Reimbursement Policy Update - Allergy Treatment: Immunotherapy
Hemophilia drugs authorization update effective November 15, 2015
Formulary Change Notice Effective December 1, 2015
Quarterly pharmacy formulary change notice effective February 1, 2016
Q4 Medical Policies and Clinical Utilization Management Guidelines Update
 2016
2016 Summary of Benefits
Custom Molded Orthotics Require Prior Authorization 15, 2015
Precertification for knee arthroscopy effective April, 1 2016
Precertification for knee and hip arthroplasty effective May 1, 2016
Radiation Therapy: Select Brachytherapy, IMRT CPT codes require prior authorization effective May 1, 2016
New for PCP – reimbursement for interdisciplinary care team (ICT) participation
Precertification changes for custodial nursing facility care
Prenatal Ultrasound Policy/ICD-10 Update
Additional Radiation Oncology PAs Directed to AIM
Coverage guidelines and Clinical Utilization Management Guidelines update
Update on Pharmacy Prior Authorization Submissions
Precertification for knee and spine orthoses effective July 1, 2016
Discontinuation of Trividia Health (formerly Nipro Diagnostics, Inc.) diabetic supplies
Quarterly pharmacy formulary change notice effective July 1, 2016
Precertification update for vascular embolization or occlusion services
Update on precertification requirements for knee and spinal orthoses
Quarterly pharmacy formulary change notice effective September 1, 2016
Update on precertification requirements for knee and spinal orthoses
Federal nondiscrimination and accessibility update.
ICS Quarterly pharmacy formulary change notice effective September 1, 2016
Quarterly pharmacy formulary change notice effective September 1, 2016
QVAR pharmacy formulary change notice effective September 1, 2016
New Injectable Infusible Drugs - Emend (fosaprepitant), Aloxi (palonosetron) and Afstyla (antihemophilic)
Zika Virus Information Packet
Quarterly pharmacy formulary change notice effective November 1, 2016
Change to inpatient diagnosis-related group claim submissions
Prior authorization requirements for new injectable/infusible drugs: Darzalex (daratumumab) and Empliciti (elotuzumab)
HealthKeepers, Inc. home health authorization and billing requirements - Effective November 1, 2016
Quarterly pharmacy formulary change notice effective February 1, 2017
Istodax, Ixempra, Doxil, Torisel, Inflectra
PA required for elective Coronary Artery Bypass Graft
 2017
Quarterly pharmacy formulary change notice effective March 1, 2017
Additional information on ClaimCheck® upgrade to ClaimsXten™
Screen for Lead: Every Child, Every Time
Quarterly pharmacy formulary change notice effective May 1, 2017
Amendment to Provider Agreement
Genetic Testing Services Prior Authorization
Beginning in April: Access Patient360 directly through the Availity Web Portal
Update to the ClaimsCheck® upgrade to ClaimsXten™
Inpatient Readmissions Update
Modifier FX and Reimbursement Policy Update (MMP)
Wheelchair component or accessory, not otherwise specified to require prior authorization
Quarterly pharmacy formulary change notice effective August 1, 2017
Q1 Coverage Guidelines and Clinical Utilization Management Guidelines update
Hospice amendment effective August 1, 2017
Early intervention services amendment effective August 1, 2017
Hemophilia factor injections to require prior authorization
Lead Testing FAQ
Q2 Coverage Guidelines and Clinical Utilization Management Guidelines update
Americans with Disabilities Act compliance
Orthotics to require prior authorization
Anthem CCC Plus Long-term Services and Supports Authorization Guide
Quarterly pharmacy formulary change notice effective November 1, 2017
Include National Provider Identifier on surgical procedure UB04 bills - MMP
New review process for not otherwise classified drug codes
New case management program to identify PTSD in parents of infants in the NICU
Mavyret pharmacy formulary change notice effective November 1, 2017
Q3 Coverage Guidelines and Clinical Utilization Management Guidelines update
Anthem CCC Plus Service Registration Form
 2018
Vaccines for Children (VFC) Program
Healthy Rewards Flier
Quarterly pharmacy formulary change notice effective February 1, 2018
Age limits pharmacy formulary change notice effective February 1, 2018
Levoleucovorin calcium, elosulfase alfa, histrelin acetate, idursulfase and fulvestrant to require prior authorization
Q3 Medical Policies and Clinical Utilization Management Guidelines Updates
Elotuzumab to require prior authorization
Anthem CCC Plus Eight injectable drugs will require prior authorization
Eight injectable drugs will require prior authorization
Global Surgical Package for Professional Providers
ICS Pharmacy Formulary Change Notice
Anthem CCC Plus 2018 Utilization Management Affirmative Statement
Medical Policy update - Hyaluronan Injections
Anthem CCC Plus Prior authorization requirement update for Mylotarg
Prior authorization requirement update for Mylotarg
Q4 Medical Policies and Clinical Utilization Management Guidelines Updates
Quarterly pharmacy formulary change notice effective May 1, 2018
Electrical stimulation device to require prior authorization
Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Lower extremity vascular intervention codes require prior authorization
Prior authorization requirements for Darzalex drug
ICS pharmacy formulary change notice update: effective April 15, 2018
Services requiring prior authorization
Zepatier, cough and cold pharmacy formulary change notice effective June 1, 2018
Prior authorization requirements for injectable/infusible drugs: mepolizumab (Nucala) and reslizumab (Cinqair)
Prior authorization requirements for Cabazitaxel
HealthKeepers, Inc. adopts 22nd edition of the MCG care guidelines
New Baby, New Life Flier
Quarterly pharmacy formulary change notice effective August 1, 2018
January - 2018 Medical Policies and Clinical Utilization Management Guidelines update
March - 2018 Medical Policies and Clinical Utilization Management Guidelines update
Provider Orientation Invite
Medical Policies and Clinical Utilization Management Guidelines update - May 2018
Prior authorization requirements for Somatrem
Prior authorization requirements for Interferon beta-1a
Quarterly pharmacy formulary change notice effective October 1, 2018
Precertification requirements effective October 5, 2018
Cervical length measurement by transvaginal ultrasound
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 Subcutaneous Implantable Defibrillator system
Prior authorization requirements for Sublocade
July 2018 Medical Policies and Clinical Utilization Management Guidelines update
September 2018 Medical Policies and Clinical Utilization Management Guidelines update
 2019
Requirements for Documentation of Proof of Timely Filing
Quarterly pharmacy formulary change notice effective January 1, 2019
Quarterly pharmacy formulary change notice effective February 1, 2019
Policy Update - Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service (Policy 06-003, eff 04/01/2019)
Clinical Criteria updates
Correction: Cervical length measurement by transvaginal ultrasound
November 2018 Medical Policies and Clinical Utilization Management Guidelines update
Clinical Criteria updates - Posted 3/8/2019
Authorization changes for procedure codes
Quarterly pharmacy formulary change notice effective May 1, 2019
2019 Utilization Management Affirmative Statement concerning utilization management decisions
Elderly or Disabled with Consumer Direction Waiver updates
Prepayment clinical validation review process
Unspecified DX Code Update
Electronic claim payment reconsideration
Availity claim payment disputes webinar training
Quarterly pharmacy formulary change notice effective August 1, 2019
January 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy
Clinical Criteria Web Posting Q2 2019
Provider Satisfaction Survey information
Clinical Criteria Web Posting Q1 2019
Evaluation and management services -over-coded services
Customization for IP Cancer Therapy
Clinical Laboratory Improvement Amendments
Prior authorization changes
Taxonomy codes
Medical necessity review for appropriate level of care
Pharmacy benefit manager change to IngenioRx
Medroxyprogesterone Injectives Formulary Change Notice
Electronic Visit Verification (EVV) Provider Bulletin
Clinical Criteria Web Posting July 2019
March 2019 Medical Policies and Clinical Utilization Management Guidelines Update
June 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Prenatal service third-party liability change
Drug Screen Testing Update
Prior authorization requirements changes effective November 1, 2019
Quarterly pharmacy formulary change notice effective November 1, 2019
Clinical Criteria Web Posting August 2019
Global 3M19 Medical Policy and Technology Assessment Committee prior authorization requirement updates
August 2019 Medical Policies and Clinical Utilization Management Guidelines Update
Clinical Criteria Web Posting September 2019
Improving the Patient Experience – CME
November is Diabetes Awareness Month
Multiple and Bilateral Surgery: Professional and Facility Reimbursement Policy Update
Quarterly pharmacy formulary change notice effective January 1, 2020
Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Reimbursement Policy Update
 2020
Locum Tenens Physicians/Fee-for-Time Compensation
Distinct Procedural Services (Modifiers 59, XE, XP, XS, XU)
Emergency Services: Nonparticipating Providers and Facilities
Robotic Assisted Surgery
Split-Care Surgical Modifiers
Reimbursement for Reduced and Discontinued Services
Unlisted, Unspecified or Miscellaneous Codes
Inpatient Readmissions
DRG Inpatient Facility Transfers
Facility Take-Home DME and Medical Supplies
Durable Medical Equipment (Rent to Purchase)
Reimbursement for Maximum Units Per Day
Anthem HealthKeepers Plus Provider Manual
Correct Claims
Anthem Antiemetic/Antivertigo Medications Prior Authorization Form
Critical Incident Reporting Form
Tidewater Region
Anthem CCC Plus Oral Buprenorphine Prior Authorization Form
Anthem CCC Plus Short and Long-Acting Opioid Prior Authorization Form
Central Region
Anthem Methadone Prior Authorization Form
Charlottesville Western
Southwest Region
Roanoke Alleghany Region
Northern/Winchester Region
Tidewater Region Provider Directory
Roanoke Alleghany Region Provider Directory
Southwest Region Provider Directory
Central Region Provider Directory
Charlottesville Western Region Provider Directory
Northern Winchester Region Provider Directory
Anthem Healthkeepers Plus Critical incident and quality of care reporting presentation
Anthem Antimigraine Prior Authorization Form
Provider Orientation Invite 2020
Anthem Hepatitis C Antivirals Preferred Prior Authorization Form
Electronic visit verification claims receiving denial code Z79
Update: electronic visit verification transition period extended
Revision to evaluation and management services — over-coded services postponed
Quarterly pharmacy formulary change notice effective February 1, 2020
BH Interactive Care Reviewer Training Presentation
Incorrect Claims Payments Alert
Coding Spotlight — Pregnancy
Coding tip for psychological and neuropsychological testing
Availity Provider Notification
Clinical Criteria Web Posting November 2019
New value-added benefit for Anthem HealthKeepers Plus members
November 2019 Clinical Utilization Management (UM) Guidelines
Clinical Criteria Web Posting December 2019
Prior authorization requirements: new 2020 codes for coverage and precertification
Authorizations extended for LTSS services due to COVID-19
COVID-19 information (June 4 update)
Provider Flexibilities Related to COVID-19 (March 19, 2020)
Changes related to COVID-19 (March 25, 2020)
DMAS COVID-19 Frequently Asked Questions (March 26, 2020)
Prior authorization requirements for 97537
Provider manual excerpt — claim payment disputes
Guidelines for Providers of Behavioral Health and Developmental Services Following the Issuance of Executive Order 53 on March 23, 2020
Social Determinants of Health
Social Determinants of Health Presentation
Clarifications and Changes: Behavioral Health and ARTS Provider Flexibilities Related to COVID-19
Acquisition of Beacon Health Options
COVID-19 update: HealthKeepers, Inc. suspends select prior authorization rules and announces significant policy adjustments in response to unprecedented demands on health care providers
New functionality added to Availity’s provider enrollment tool for Virginia
Electronic submission is preferred method for requesting pharmacy prior authorization
MCG care guidelines — 24th edition
Federal resources available for health care providers and employers in the federal CARES Act
Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19
Clinical Criteria Web Posting February 2020
Listen now! Webinar recording available from HealthKeepers, Inc. for network providers on SBA loans and other federal relief programs in response to COVID-19
2020 affirmative statement concerning utilization management decisions
Reimbursement for outpatient physical therapy, occupational therapy and speech therapy services via telehealth
Quarterly pharmacy formulary change notice effective May 1, 2020
Modifier use reminders
Mental Health Rehabilitative Services Supplement - Behavioral Therapy
Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline
Interactive Care Reviewer (ICR) Presentation
COVID-19 Facility Closure and Reopening List from DMAS as of June 9, 2020
New behavioral health discharge call-in line
Updates to AIM Specialty Health advanced imaging Clinical Appropriateness Guidelines
February 2020 Clinical Utilization Management (UM) Guidelines
February 2020 Medical Policies and Clinical Utilization Management Guidelines update
Behavioral Health Concurrent Review Form for Mental Health Inpatient, PHP and IOP
Behavioral Health Initial Review Form for Mental Health Inpatient, PHP and IOP
Prior authorization requirements for angiographic evaluation of stenotic or thrombosed dialysis circuits
Quarterly pharmacy formulary change notice effective July 1, 2020
Clinical Criteria Web Posting March 2020
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 15, 2020)
Behavior Therapy Provider Flexibility Update (6/15/2020)
Governor's Executive Orders for Access to Medicaid Covered Health Care Services in Response to Novel Coronavirus (COVID-19) (June 16, 2020)
Maternity Notification Form
Coronavirus relief funds (June 22, 2020)
Anthem Narcolepsy Medications Prior Authorization Form
Anthem Palforzia Prior Authorization Form
Provider demographics update
Virginia Medicaid Agency Announces Emergency Relief for Providers
New MCG Care Guidelines 24th edition Viral Illness
Transition to AIM Specialty Health Rehabilitative Services Clinical Appropriateness Guidelines
Clinical Criteria Web Posting May 2020
Addressing oral health in early childhood
Clarifications and Changes: Group-Based Service Delivery in Behavioral Health and Addiction and Recovery Treatment Services (ARTS) during the COVID-19 State of Emergency (7/1/2020)
COVID-19 Policy Continuation and Timeline (7/15/2020)
COVID-19 Continuations Until 8/31/20 and 10/22/20 (8/24/2020)
COVID-19 Payment Increase for Medallion 4 Providers of Certain Evaluation and Management Codes (7/2/2020)
Change to transportation vendor
May 2020 Clinical Utilization Management (UM) Guidelines
November 2019 Medical Policies and Clinical Utilization Management Guidelines update
MCS Notification of Delivery Form
May 2020 Medical Policies and Clinical Utilization Management Guidelines Update
Quarterly pharmacy formulary change notice effective August 1, 2020
Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19 (August 10, 2020)
Coverage of COVID-19 Antibody Lab Tests (August 11, 2020)
Nurse Practitioner and Physician Assistant Services
COVID‐19 Response ‐ DMAS Behavioral Health Providers & Stakeholders (August 24, 2020)
MCO Guidance on COVID-19 Flexibilities on Face-to-Face Requirements As of August 13, 2020
Clinical Criteria Web Posting June 2020
Prior authorization requirements for E0482
Racial disparities provider presentation
Consumer Assessment of Healthcare Providers and Systems (CAHPS) Overview
New Baby, New Life Provider Booklet
Preventable Adverse Events
Provider Chat — A fast, easy way to have your questions answered
New specialty pharmacy medical step therapy requirements
Herceptin Biosimilars Medical Step Therapy Notice
CCC plus Open Enrollment
Avastin Biosimilars Medical Step Therapy Notice
Prior authorization requirements for HCPCS code 55899
Updates on COVID-19 Continuation and Timelines for Behavioral Health and Addiction and Recovery Treatment Services (October 7, 2020)
Quarterly pharmacy formulary change notice effective November 1, 2020
Provider Digital Engagement
Change Healthcare Medical Attachment Functionality FAQ
VA Hazard Pay
Transition to AIM small joint guidelines
Anti-VEGF Medical Step Therapy Notice