Anthem: Important COVID-19 Update: Prior Authorization and Other Policy Adjustments (Updated December 22, 2020)

Laboratory tests for COVID-19 at both in-network and out-of-network laboratories will be covered with no cost sharing for members.

Claims audits, retrospective review, peer to peer review and policy changes

Anthem will adjust the way we handle and monitor claims to ease administrative demands on providers:

Hospital Claims audits requiring additional clinical documentation will be limited through June 24, 2020, though Anthem reserves the right to conduct retrospective reviews on these findings with expanded lookback recovery periods for all lines of business except Medicare. To assist providers, Anthem can offer electronic submission of clinical documents through the provider portal.

Retrospective utilization management review will also be suspended through June 24, 2020, and Anthem reserves the right to conduct retrospective utilization management review of these claims when this period ends and adjust claims as required.

Suspend peer to peer reviews through June 24, 2020, except where required pre-denial per operational workflow or where required by State during this time period for all lines of business except Medicare.

Our Special Investigation programs targeting provider fraud will continue, as well as other program integrity functions that help ensure payment accuracy.
 

Otherwise, Anthem will continue to administer claims adjudication and payment in line with our benefit plans and state and federal regulations, including claims denials where applicable. Our timely filing requirements remain in place, but Anthem is aware of limitations and heightened demands that may hinder prompt claims submission.

Source: https://providernews.anthem.com/new-hampshire/article/important-covid-19-update-prior-authorization-and-other-policy-adjustments-9