![]() ![]() Respiratory services for acute treatment of COVID-19 will be covered.Prior authorization requirements are suspended for COVID-19 Durable Medical Equipment including oxygen supplies, respiratory devices, continuous positive airway pressure (CPAP) devices, non-invasive ventilators, and multi-function ventilators for patients who need these devices for COVID-19 treatment, along with the requirement for authorization to exceed quantity limits on gloves and masks.Concurrent review for discharge planning will continue unless required to change by federal or state directive.This helped prevent the need for additional outreach to Anthem to adjust the date of service covered by the authorization. Extended the length of time a prior authorization issued on or before May 30, 2020, was in effectfor elective inpatient and outpatient procedures to 180 days.Although prior authorization was not required, Anthem requested voluntary notification via the usual channels to aid in our members’ care coordination and management. Prior authorization requirements were suspended for patient transfers through May 30, 2020. Prior authorization was waived for patient transfers from acute IP hospitals to skilled nursing facilities, rehabilitation hospitals, long-term acute care hospitals, and Behavioral Health residential/intensive outpatient/partial hospitalization programs, and to home health including ground transport in support of those transfers.Anthem reserves the right to audit patient transfers. These adjustments applied for our fully-insured and self-funded employer, individual, Medicare and Medicaid plan members receiving care from in-network providers. While prior authorization was not required, we required notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Prior authorization requirements were suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective November 23, 2020, through January 31, 2021.These adjustments applied for our fully-insured and self-funded employer, individual and Medicare plan members receiving care from in-network providers. While prior authorization was not required, we required notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. ![]() Prior authorization requirements were suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective September 7, 2021, through October 31, 2021.These adjustments applied for our Medicare plan members receiving care from in-network providers. While prior authorization was not required, we required notification of the admission via the usual channels and clinical records on day two of admission to aid in our members’ care coordination and management. Prior authorization requirements were suspended for patient transfers from acute IP hospitals to skilled nursing facilities effective January 5, 2022, through February 7, 2022.For the most up-to-date information about the changes FEP is making, go to. Where permissible, these guidelines apply to Federal Employee Plan (FEP ®) members. Medicare adjustments and suspensions may have different timeframes or changes where required by federal law. These adjustments apply to members of all lines of business except as noted below, including self-insured plan members and in-network and out-of-network providers, where permissible. Unless otherwise required under State and Federal mandates, Anthem health plans are making adjustments to assist providers in caring for members. Medicare: Medicare Advantage Provider NewsĬOVID-19 Update: Anthem updates guidance on prior authorization requirements and other policy adjustments in response to unprecedented demands on health care providersĪnthem recognizes the intense demands facing doctors, hospitals and health care providers in the face of the COVID-19 crisis. Medicaid: Medicaid Provider News – COVID-19 Please review the Medicare and Medicaid specific sites noted below for details about these plans. Please note that the following information applies to Anthem Blue Cross and Blue Shield (Anthem)’s Commercial health plans. ![]()
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