Wisconsin
Provider Communications

August 2021 Anthem Provider News - Wisconsin

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Title Category

Anthem to update formulary lists for commercial health plan pharmacy benefit effective October 1, 2021*

*Material Adverse Change (MAC)
Pharmacy

Change in email submission of service requests for Federal Employee Program® members*

*Material Adverse Change (MAC)
Federal Employee Plan (FEP)

Clearing up coding confusion for retinal eye exams (DRE)

Administrative

Immune globulin adjusted body weight dosing program beginning August 1, 2021

Pharmacy

Medicaid News - August 2021

View these Medicaid articles:
-Iron Infusion Step Therapy
-Prior authorization requirement changes effective September 1, 2021 – UM AROW 1837
-Iron Infusion Prior Authorization Update
Medicaid

Medicare News - August 2021

View these Medicare articles:
- Infliximab Step Therapy - Effective 7/15/2021
- Prior authorization requirement changes effective October 1, 2021 – UM AROW 1907
Medicare

New! Schedule appointments online through Availity

Digital Tools

Pharmacy information available at anthem.com

Pharmacy

Preventing claims denials: Shingles vaccine

Medicare

Register now for our August CME webinars

Administrative

Reimbursement policy update: Claims requiring additional documentation (Facility)*

*Material Adverse Change (MAC)
Reimbursement Policies

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, & XU*

*Material Adverse Change (MAC)
Reimbursement Policies

Reimbursement policy update: Virtual Visits (Professional and Facility)*

*Material Adverse Change (MAC)
Reimbursement Policies

Specialty dose rounding program for certain non-oncology medications beginning August 1, 2021

Pharmacy

Specialty dose rounding program for certain oncology medications

Pharmacy

Telehealth visits can impact after hospitalization follow-up care for mental illness

Administrative

Transition to AIM Specialty Health imaging of the heart clinical appropriateness guideline for computed tomography to detect coronary artery calcification

Medical Policy & Clinical Guidelines

Updates for specialty pharmacy are available - August 2021*

*Material Adverse Change (MAC)
Pharmacy
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