Summit Community Care Provider Newsletter – October 2024

This month’s featured articles:

Digital Solutions

Notice of Material Amendment to Healthcare Contract

• Mandatory data attestation requirement in Availity Essentials
• Digital-only authorization case status notification coming to you
• Roster Automation updates effective November 15, 2024: enhanced reporting to increase data accuracy

Policy Updates

Notice of Material Amendment to Healthcare Contract

• Clinical Criteria updates

Reimbursement Policies

• Clarification to reimbursement policy update:  Nurse Practitioner and Physician Assistant Services

Pharmacy

Notice of Material Amendment to Healthcare Contract

• Prior authorization updates for medications billed under the medical benefit

Notice of Material Amendment to Healthcare Contract

• Prior authorization updates for medications billed under the medical benefit

Quality Management

• Prevent flu and COVID-19: drive the change through vaccination
• HEDIS medical record submission made easier with our Remote EMR Access service

Anthem Provider Newsletter – Missouri October 2024

This month’s featured articles:

Administrative

• National Accounts 2025 precertification list

Digital Solutions

• Digital Provider Enrollment now available for additional provider types in Availity Essentials
• Roster Automation updates effective November 15, 2024: enhanced reporting to increase data accuracy
• Introducing the Care Provider Recognition Program from Anthem

Education and Training

• Seamless advance care: My Directives digital tool for D-SNP members

Policy Updates

• Clinical Criteria updates

Medical Policy & Clinical Guidelines

• Medical Policies and Clinical Utilization Management Guidelines update

Prior Authorization

• Prior authorization requirement changes
• Changes to special supplemental benefits for the chronically ill eligibility requirements

Reimbursement Policies

• Reimbursement policy update: Modifiers 59 and XE, XP, XS, and XU: Distinct Procedural Service — Professional
• Clarification to reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

• Introduction of the Specialty High Performing Provider designation program for commercial networks
• Introduction of the HPP designation program for individual member (Exchange) commercial networks

Pharmacy

• Pharmacy information available on our provider website
• Specialty pharmacy updates — October 2024
• Medicare Part D overhaul: What’s new in 2025 for your prescription drug costs?

Quality Management

• Prevent flu and COVID-19: drive the change through vaccination
• HEDIS medical record submission made easier with our Remote EMR Access service

Sign up for online orientation sessions.

Beginning November 1, EviCore by Evernorth^® will manage precertification for Current Procedural Terminology (CPT^®) codes for molecular laboratory tests for Cigna Healthcare^℠ customers.

What this means to you

Obtain precertification for molecular laboratory tests from EviCore by:

• Website: EviCore.com/Provider
• Telephone (866.668.9250)
• Fax (855.774.1319)

Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*

Online learning sessions

Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:

1. Go to evicore.webex.com.
2. Select “Webex Training” from the menu bar on the left.
3. Click the “Upcoming” tab. Choose “Cigna Molecular Laboratory Tests Provider Orientation.”
4. Click “Register” next to the session you wish to attend.
5. Enter the registration information.

After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.

If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.

Additional information

For more information about precertification for molecular laboratory tests, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.

Sign up for online orientation sessions.

Beginning November 1, EviCore by Evernorth^® will manage precertification for Current Procedural Terminology (CPT^®) codes for vascular intervention procedures for Cigna Healthcare^℠ customers.

What this means to you

Obtain precertification for vascular intervention procedures from EviCore by:

• Website: EviCore.com/Provider
• Telephone (866.668.9250)
• Fax (855.774.1319)

Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*

Online learning sessions

Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:

1. Go to evicore.webex.com.
2. Select “Webex Training” from the menu bar on the left.
3. Click the “Upcoming” tab. Choose “Cigna Vascular Intervention Procedures Provider Orientation.”
4. Click “Register” next to the session you wish to attend.
5. Enter the registration information.

After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.

If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.

Additional information

For more information about precertification for vascular intervention, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.

Sign up for online orientation sessions.

Beginning November 1, EviCore by Evernorth^® will manage precertification for Current Procedural Terminology (CPT^®) codes for spine surgeries for Cigna Healthcare^℠ customers.

What this means to you

Obtain precertification for spine surgeries from EviCore by:

• Website: EviCore.com/Provider
• Telephone (866.668.9250)
• Fax (855.774.1319)

Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*

 Online learning sessions

Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:

1. Go to evicore.webex.com.
2. Select “Webex Training” from the menu bar on the left.
3. Click the “Upcoming” tab. Choose “Cigna Musculoskeletal Spine Provider Orientation.”
4. Click “Register” next to the session you wish to attend.
5. Enter the registration information.

After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.

If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.

Additional information

For more information about precertification for spine surgery, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.

Anthem Provider Newsletter – Missouri September 2024

This month’s featured articles:

Administrative

• Clinical Laboratory Improvement Amendments
• Drug and biologic

Digital Solutions

• Maximizing care with regular provider data attestation
• Advancing digital efficiency by discontinuing paper remittances
• Save time and get better results with optimized CPT code search in Availity Essentials
• Digital-only authorization case status notification coming to you

Education and Training

• New provider resource for family caregivers of members with cancer

Medical Policy & Clinical Guidelines

• Medical Policiesand Clinical UM Guidelines updates — September 2024

Prior Authorization

• Prior authorization requirement changes

Federal Employee Program (FEP)

• FEP Quality Reimbursement Program for providers

Long-Term Services and Supports

• The Power of the Blues: Introducing the Blue National Physician Performance Dataset

Pharmacy

• Specialty pharmacy updates — September 2024
• Pharmacy information available on our provider website
• Real-time prescription benefit
• Anthem expands specialty pharmacy precertification list
• Anthem expands specialty pharmacy precertification list

Quality Management

• Announcing the new HEDIS documentation library supporting coding excellence

Summit Community Care Provider Newsletter – August 2024

This month’s featured articles:

Administrative

Notice of Material Amendment to Healthcare Contract

• Drug and biologic

Digital Solutions

• Coming soon — digital-only authorization case status notifications
• Advancing digital efficiency by discontinuing paper remittances
• Maximizing care with regular provider data attestation

Policy Updates

Notice of Material Amendment to Healthcare Contract

• Clinical Criteriaupdates

Medical Policy & Clinical Guidelines

Notice of Material Amendment to Healthcare Contract

• Medical Policiesand Clinical Utilization Management Guidelines update

Prior Authorizatio1

Notice of Material Amendment to Healthcare Contract

• Prior authorization requirement changes

Cigna – Medicare Advantage Policy Uupdate Facility Claims for ER EM Services 082524

As a result of a recent review, we will review facility claims submitted with emergency room (ER) evaluation and management Current Procedural Terminology (CPT®) code 99285 for billing and coding accuracy. Claims may be adjusted and reimbursed at a more
appropriate CPT code level.

Administrative appeal rights are available. We will update the Emergency Room Services (MAR36) reimbursement policy to reflect this change.

This update is effective for dates of service on or after August 25, 2024, and applies if the customer was discharged from the ER.

Summit Community Care appreciates the compassion with which you care for your patients, our members. We know the delivery of high-quality mental healthcare services for Summit Community Care members requires successful collaboration. Because timely decisions and successful approvals of medically necessary services are an important part of collaboration, we encourage you to review the following information.

Summit Community Care – Understanding psychological and neuropsychological testing services