August 2020 - Provider - REG ANH BSH

August 2020

In addition to the summary of monthly changes below, please also review our monthly Bulletin for recent and upcoming changes to our medical and dental policies, and associated changes to pre-authorization requirements. The Medical Policy Manual includes a list of recent updates and archived policies.

Pre-authorization updates

In our February and April 2020 issues of The Connection, we notified you that oxygen concentrators used by Medicare Advantage members for more than 90 days will require pre-authorization. The effective date of this requirement has changed to August 1, 2020.

Commercial, Uniform Medical Plan and Medicare Pre-authorization Lists
Pre-authorization suspended until August 1, 2020:

  • Noninvasive Ventilators in the Home Setting
  • Because of the COVID-19 pandemic, pre-authorization requirements for noninvasive ventilators, HCPCS E0466, have been suspended until August 1, 2020

Medical policy updates

We publish updates to medical policies and Clinical Position Statements in our monthly publication, The Bulletin.

We provided 90-day notice in the May 2020 issue of The Bulletin about the following
medical policies effective August 1, 2020:

  • Identification of Microorganisms Using Nucleic Acid Probes (Genetic Testing #85)
  • New and Emerging Medical Technologies and Procedures (Medicine #149)

Medical and dental reimbursement policy updates

We review our reimbursement policies on an annual basis. Included below are changes to our policies.

View our Reimbursement Policy Manual or our Dental Reimbursement Policy Manual.

To see how a medical claim will pay, access the Clear Claim Connection tool on the Availity Provider Portal.

We revised our Cellular and Gene Therapy Products (Medicine #112) medical reimbursement policy effective August 1, 2020.

Read the June 2020 issue of our newsletter for details.

AIM revising clinical guidelines

AIM Specialty Health (AIM) is revising the following clinical guidelines for our radiology program effective August 16, 2020:

  • Sleep Disorder Management
  • Advanced Imaging: Chest Imaging
  • Advanced Imaging: Oncologic Imaging

Revised guidelines are available on AIM’s website.