Anthem Provider Newsletter – November, 2023

November 01, 2023

Anthem Provider Newsletter – Missouri November 2023

This month’s featured articles:

Digital Tools

Education and Training


Policy Updates

Reimbursement Policies

Federal Employee Program


Quality Management | Commercial / Medicare Advantage


Cigna Network News – Fourth Quarter 2023

October 25, 2023

Click on the following link to access the current edition of Cigna Network News.

Cigna Network News 4th Quarter 2023

Cigna – HIV pre-exposure prophylaxis services

October 23, 2023

We routinely review our coverage, reimbursement, and administrative policies for potential updates.

As a result of a recent review, we have updated the Preventive Care Services Administrative Policy (A004) to include International Classification of Diseases, 10th Revision (ICD-10) diagnosis code Z29.81: Encounter for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP).

What this means

Effective for dates of service on or after October 1, 2023, ICD-10 code Z29.81 should be used when submitting claims for encounters for HIV PrEP services.

In accordance with the Affordable Care Act, we will cover these services without a cost share.


Additional information

For additional guidance, view the Preventive Care Services Administrative Policy (A004).

Cigna – Medical necessity review for physical and occupational therapy services performed in office

October 16, 2023

American Specialty Health® (ASH) now manages the medical necessity review program for Cigna Healthcare–contracted providers who render physical therapy (PT) and occupational therapy (OT) services for customers with Cigna Healthcare commercial and Individual & Family Plans in certain ASH-managed markets.

This policy update only applies to PT/OT services performed in a provider’s office; it does not apply to those performed in an outpatient hospital setting.

What this means for you

PT and OT services that require a medical necessity review can be submitted either preservice or post-service. Submission of the clinical treatment plan is typically not required until after the patient’s fifth visit.

 How to submit review requests

There are three ways to submit medical necessity review requests:

  • ASHLink website:
  • Fax: 877.248.2746.
  • Mail: PO Box 509077, San Diego, California 92150.

Additional information

To ensure a timely review, requests should include the clinical treatment plan, necessary clinical information, and progress documentation.

ASH clinicians will review requests using evidence-based medicine and Cigna Healthcare coverage guidelines to determine medical necessity. Following the review, ASH will issue a determination to the requesting provider and Cigna Healthcare customer.

Coverage guidelines

The PT and OT coverage guidelines are available on the Cigna for Health Care Professionals website (

Learn more

Additional information is available on If you have questions, contact the ASH customer service department at 800.972.4226 (option 2).

FedEx Employees Moving to United Healthcare Surest Plan

October 05, 2023

Effective 01/01/2024 FedEx employees will be moving to the UHC Surest Plan.  This plan accesses the UHC Choice Plus network which Mercy is contracted with Ministry wide.

The link below will take you to the announcement from UHC and contains general information on the change.  You will also find additional links on the announcement that will take you to the UHC website for more information on Surest.

UHC FedEx Announcement

This link is for a webinar session offered by UHC that will provide additional information on Surest and FedEx.  The webinar is scheduled for 10/12/2023 at 12:00 pm CST.

Webinar: Get to Know Surest| Surest health plan

If you have any issues registering for the webinar, please contact the Surest team at

Cigna Medicare Advantage – Best Practices Flyer

October 05, 2023

Cigna MA – Medicare_AcuteHistorySequela_Flyer

Cigna Healthcare is committed to providing you with resources and support to ensure more accurate coding and documentation of chronic conditions.

To that end, we developed a best practices flyer that reviews the documentation and International Classification of Diseases, Tenth Revision, Clinical Modification coding as acute, history, or sequela. Examples are provided for myocardial infarction (MI), cancer, and stroke.

Why it matters

Employing best practices and adhering to Centers for Medicare & Medicaid Services (CMS) guidelines for documentation and coding of chronic conditions can help enhance the quality of patient care.

Your next steps

For your convenience, we have attached the best practices flyer. Additional documentation and coding resources are available on the Cigna Healthcare for Medicare Providers website ( > Provider Education > Documentation and Coding Resources).


Cigna Medicare Advantage – Prior Authorization Updates

October 05, 2023

Cigna MA – Authorizations Changes 100123

As you know, one of our goals is to keep patients safe, while improving health outcomes and making care more affordable. One of the ways we do that is through prior authorization, which helps to ensure patient health, safety, and affordability by adhering to evidence-based standards of care.

We update prior authorization requirements on a quarterly basis to align with program or CPT and HCPCS code changes, as well as industry standards. Effective for dates of service on or after October 1, 2023, we removed over 460 codes and added 14 codes to the prior authorization requirements list.

Accessing a list of services that require prior authorization

Cigna – Reimbursement Update – COVID-19 Laboratory Services

October 04, 2023

Cigna Reimbursement Update – COVID-19 Laboratory Services 122123

Guidelines to add 21 COVID-19 laboratory service codes. These services will be  administratively denied when administered at a frequency greater than the medically unlikely edits set by CMS.

Denials will affect the claim line only and include administrative appeal rights. This update is effective for dates of service on or after December 21, 2023.


Anthem Provider Newsletter – October, 2023

October 02, 2023

Anthem Provider Newsletter – Missouri October 2023

This month’s featured articles:


Digital Tools

Education and Training


Policy Updates

Medical Policy & Clinical Guidelines

Reimbursement Policies