Aetna Office Link Updates – September 2020 (004)

This month’s featured articles…

Products & Programs:

• Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020
• Meet your Cancer Care Navigator
• Predictive analytics guide proactive support to patients undergoing chemotherapy resulting in lowered admissions

Pharmacy:

• Anthem to update formulary lists for commercial health plan pharmacy benefit
• Specialty pharmacy updates are available – September 2020

Administrative:

• New provider directory indicators for medication assisted treatment (MAT) providers
• The 2020 Provider Manual is now available
• Eye exam benefit for St. Louis police
• EDI Gateway migration deadline is September 15, 2020
• Providers can now receive and respond to medical record requests for post-pay audit via Change Healthcare’s Assurance Attach Assist Module
• Enhanced medical records submission process to support claims processing
• Patient360 adds care gap alert feedback for medical providers
• Anthem Commercial Risk Adjustment (CRA) Reporting Update:  2020 Prospective Program continues

Reimbursement Policies:

• Reimbursement policy update: Distinct Procedural Services-Modifiers 59, XE, XP, XS, XU (Professional)
• Reimbursement policy update: Frequency Editing (Professional)

Medicare:

• Update: Notice of changes to the AIM musculoskeletal program
• Medical drug benefit clinical criteria updates
• IUOE 513 Welfare Fund moves to Anthem Medicare Preferred (PPO) medical plan

Anthem Provider Newsletter – Missouri September 2020

Cigna – Coverage Policy Update – Total Knee and Hip Replacement 110620

Cigna – Coverage Policy Update- Unilateral duplex scans 111620

Cigna – Coverage Policy Updates – Pulse Oximetry 111520

This month’s update from Aetna…

·         Important changes to advanced reproductive technologies (ART) benefits

Aetna Monthly Update August 2020

This month’s featured articles…

FEATURE ARTICLE

• Health disparities worsened by COVID-19: Provider resources

POLICY UPDATES

• Preventive care services policy updates
• Precertification of certain gastroenterology procedures for Individual & Family Plans
• High-tech radiology site of care medical necessity review

ELECTRONIC TOOLS

• Quicker option to submit pended claim documentation
• Coming soon: Online claims reconsideration requests
• Coming soon: Online benefit viewing through procedure code lookup
• Webinar schedule for digital solutions

CLINICAL NEWS

• Pap smears and bimanual pelvic exams under age 21 usually unnecessary

QUALCARE NEWS

• New QualCare section of Network News
• QualCare and Qual-Lynx workers’ compensation COVID-19 updates A NETWORK NEWS • THIRD QUARTER 2020

PHARMACY NEWS

• Lowering medication costs for those without coverage
• Site of care review for pegfilgrastim products effective September 1
• Expansion of Specialty Medical Injectables with Reimbursement Restriction list
• Accredo to provide specialty home infusion services
• Specialty medication prior authorization outreach program
• Digital connectivity capabilities through Accredo
• Oncology clinical consult service
• Transition to Express Scripts Pharmacy: Reminder

GENERAL NEWS

• Important annual screenings
• Cigna Gene Therapy Program
• Final CMS regulations give patients greater control of health care information
• PPACA risk adjustment: Accurate claim coding may benefit your patients
• Providers must meet language assistance compliance requirements

HELPFUL REMINDERS

• Market Medical Executives contact information
• Updated Cigna Reference Guides Available Fall 2020
• Quick Guide to Cigna ID Cards:  Interactive digital tool
• Urgent care for non-emergencies
• View drug benefit details using real-time benefit check
• Increase your knowledge with CareAllies education series
• Resources to enhance interactions with culturally diverse patients
• Have you moved recently? Did your phone number change?
• Get digital access to important information

Cigna Network News 3rd Quarter 2020 (002)

This month’s featured articles…

Pharmacy:

• Anthem to update formulary lists for commercial health plan pharmacy benefit
• Voluntary site of care outreach for oncology checkpoint inhibitors beginning August 1, 2020
• Anthem prior authorization updates for specialty pharmacy are available – August 2020
• Pharmacy information available on anthem.com

Administrative:

• Provider contract and fee schedule notifications coming soon Resources to support diverse patients and communities
• Evaluation and management services correct coding (Professional)
• Migrate your EDI transactions to Availity today
• Electronic claims submission – Clinical Laboratory Improvement Amendments (CLIA)
• Anthem electronic attachments – X12 275 5010
• Coming soon: Enhance your prior authorization and inpatient admission and discharge notification via electronic and digital self-service for 2020
• Medical record standards
• Appropriate coding helps provide a comprehensive picture of patients’ health

Medical Policy & Clinical Guidelines:

• Medical policy and clinical guideline updates – August 2020
• Expansion of AIM Musculoskeletal Program effective November 1, 2020

Reimbursement Policies:

• Reimbursement Policy Update: Claims requiring additional documentation (Facility)

Medicare:

• Medicare News – August 2020
• Medical drug benefit clinical criteria updates
• 2020 Medicare risk adjustment provider trainings

Anthem Provider Newsletter – Missouri August 2020

Please see attached notice regarding the following new payment and clinical policies that Home State Health will roll out effective 10/01/2020.

• Multiple Diagnostic Cardiovascular Procedure Payment
• Leveling of Care:  Evaluation & Management Overcoding
• Outpatient Testing for Drugs of Abuse.

Additional information can be found on their web site:  https://www.homestatehealth.com/providers/tools-resources/clinical-payment-policies.html

HshMOprvdrPolicyUpdate2020

This month’s featured articles…

• Update: New go-live date for level of care medical necessity review of upper and lower endoscopy procedures
• 2019 Commercial member satisfaction with behavioral health care and services survey results
• Updated coverage for HIV PrEP medications
• Anthem prior authorization updates for specialty pharmacy are available – July 2020
• Important change to prior authorization requests for inpatient hospital admissions
• Welcome to the Custom Learning Center in Availity
• Anthem Commercial Risk Adjustment (CRA) Reporting Update:  2020 Program Year Progression – What’s in it for you and your patients?
• New MCG 24th Edition Guidelines
• Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determination
• Admission review process for Anthem Blue Cross and Blue Shield Federal Employee Program® (FEP) members
• Medicare News – July 2020
• Prior authorization codes moving from AIM Specialty Health to Anthem Blue Cross and Blue Shield

Anthem Provider Newsletter – Missouri July 2020

Attached, please find a provider notice from Allwell from Home State Health regarding Medicare DRG INCREASES FOR COVID-19 TREATMENT SERVICES UNDER Coronavirus Aid, Relief, and Economic Security (CARES) Act.

COVID-19 Medicare CARES Act DRG Increases 6.15.2020

Please review and share the attached notices from Cigna regarding changes to their coverage policies.

• Coding for Prostate Needle Biopsy – Effective 8/18/2020
• Expansion of Specialty Medical Injectables – Effective 9/1/2020
• Nucleic Acid Pathogen Panel – Effective 8/16/2020
• Site of Care for Pegfilgrastim Products – Effective 9/1/2020

Cigna – Reimbursement Policy Update – Prostate Needle Biopsy 081820

Cigna – Coverage Polidy Update – Specialty Medical Injectables

Cigna – Medical Coverage Policy Update – Nucleic Acid Pathogen Panel

Cigna – Site of Care for Pegfligrastim Products 090120