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

Beginning November 1, 2024, EviCore by Evernorth will manage precertification for Current Procedural Terminology® (CPT) codes for cardiac and vascular intervention procedures for Cigna Healthcare customers.

What this means to you
The newly added vascular intervention procedures will be managed on the CareCore portal. Both the MedSolutions and CareCore portals are accessible through the EviCore provider website.

To review the complete announcement from Cigna, clickon the link below.

Cigna – Precertifiation for Vascular Intervention Procedures 110124

EviCore by Evernorth currently manages a musculoskeletal utilization management program for Cigna Healthcare customers, which includes precertification for shoulder, hip, and knee joint procedures, and interventional pain management services.

Cigna Healthcare currently manages spine-related procedures.  To help improve efficiency, beginning November 1, 2024, EviCore will also manage precertification for decompression and fusion surgery of the cervical, thoracic, lumbar spine, and sacrum.

To reach the complete announcement from Cigna, please click on the link below.

Cigna – Precertification for Spine Surgeries and Related Procedures 110124

Summit Community Care Provider Newsletter – August 2024

This month’s featured articles:

Administrative

• Mutually exclusive places of service

Digital Solutions

• Save time and get better results with optimized CPT code search in Availity Essentials
• Admission, discharge, and transfer information is now available for Medicaid members

Education and Training

• August is National Breastfeeding Month
• No-cost health risk prevention training for direct support staff
• Coming soon: Provider e-Learning Resource Center for Payment Integrity

Policy Updates

Notice of Material Amendment to Healthcare Contract

• Carelon Medical Benefits Management, Inc. updates effective October 20, 2024

Prior Authorization

Notice of Material Amendment to Healthcare Contract

• Prior authorization requirement changes

Notice of Material Amendment to Healthcare Contract

• Prior authorization requirement changes

Reimbursement Policies

Notice of Material Amendment to Healthcare Contract

• Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

• Bringing whole-person care to sickle cell disease management

Anthem Provider Newsletter – Missouri August 2024

This month’s featured articles:

Administrative

• CAA: Providers required to verify their online provider directory information
• Incidental services — facility editing update
• Device-dependent procedures — facility editing update
• ICD-10-CM Excludes1 notes
• Personalized Match update
• Provider manual update available — effective November 1, 2024

Digital Solutions

• Expansion of Carelon Medical Benefits Management, Inc. programs
• Expansion of Carelon Medical Benefits Management, Inc. programs
• Coming soon: View your fee schedule in Availity Essentials Payer Spaces
• Coming soon — digital-only authorization case status notifications for Medicare

Education and Training

• Coming soon: Provider e-Learning Resource Center for Payment Integrity
• August is National Breastfeeding Month

Policy Updates

• Clinical Criteriaupdates

Medical Policy & Clinical Guidelines

• Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines
• Updates to Carelon Medical Benefits Management Clinical Appropriateness Guidelines
• MCG Care Guidelines 28th edition
• Medical Policiesand Clinical Guidelines updates — August 2024
• Medical Policiesand Clinical Utilization Management Guidelines update

Prior Authorization

• Notification of authorization fax number changes

Reimbursement Policies

• New reimbursement policy: Intraoperative Neuromonitoring — Professional
• Reimbursement policy update: Bundled Services and Supplies — Facility
• Reimbursement policy update: Professional Anesthesia Service
• Reimbursement policy update: Modifier 78
• Reimbursement policy update: Modifiers 26 and TC — Professional
• Reimbursement policy update: Outpatient Facility Revenue Code Billing Requirements — Facility
• Reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Pharmacy

• Specialty pharmacy updates — February 2024
• Specialty pharmacy updates — August 2024