Wisconsin
Provider Communications

April 2021 Anthem Provider News - Wisconsin

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Title Category

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - April 2021

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
Administrative

Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual*

*Material Adverse Change (MAC)
Administrative

Does your practice offer telehealth services? Let us know!

Administrative

Information Center - Access important policies, forms and helpful resources

Administrative

Understanding Availity roles for electronic data interchange (EDI)

Administrative

Make the change to digital authorization/referral and hospital admission notifications using EDI

Administrative

Attention facilities: Sending admission, discharge and transfer data results in improved care management for patients

Administrative

Chat directly with a prior authorization specialist

Administrative

Keeping up with routine vaccination during COVID-19

Administrative

Interactive bilingual website taking action for our health

Exclusively developed for the Latino Community
Administrative

Join Anthem in talking about racism and its impact on health

Administrative

The health of millennials: Trends in behavioral health conditions

Behavioral Health

HEDIS 2021 Federal Employee Program® medical record request requirements

Federal Employee Plan (FEP)

Medicaid News - April 2021

View these Medicaid articles:
- There is something new happening at Anthem Blue Cross and Blue Shield
- Iron infusion medical step therapy notice
- November 2020 medical policies and utilization management guidelines update
- Prior authorization updates for specialty pharmacy drugs effective April 2021
- Prior authorization required for specialty pharmacy drugs effective May 2021
- Clinical criteria updates notification - November 2020
- Clinical criteria updates notification - December 2020
Medicaid

Medical policy and clinical guideline updates - April 2021*

*Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Update: Clinical guideline adoption postponed*

*Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

MCG Care Guidelines 25th Edition available*

*Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Updated guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)

Medical Policy & Clinical Guidelines

Maximizing efficient, high quality COVID-19 screenings*

*Material Adverse Change (MAC)
Medical Policy & Clinical Guidelines

Update for Commercial providers: AIM sleep program CPT code E1399, NOC: Durable medical equipment, miscellaneous

Medical Policy & Clinical Guidelines

Does your practice offer telehealth services? Let us know!

Medicare

In-Office Assessment program

Medicare

Oncology dose reduction program beginning July 1, 2021

Medicare

Clinical criteria updates notification - November 2020

Medicare

Clinical criteria updates notification - December 2020

Medicare

Designated specialty pharmacy network*

*Material Adverse Change (MAC)
Pharmacy

Correction: Updated formulary lists for commercial health plan pharmacy benefit effective April 1, 2021

Pharmacy

Updates for specialty pharmacy are available - April 2021*

*Material Adverse Change (MAC)
Pharmacy

Pharmacy information available at anthem.com

Pharmacy
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