Wisconsin
Provider Communications

January 2021 Anthem Provider News - Wisconsin

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Title Category

2020 Medicare risk adjustment provider trainings

Medicare

2021 FEP® benefit information available online

Federal Employee Plan (FEP)

Availity attachment tools for Anthem and affiliate payers - Live webinars

Administrative

Coding spotlight: HEDIS MY 2021

Medicaid

Disease Management/Population Health program

Medicaid

Evaluation and management changes 2021

Administrative

FDA approvals and expedited pathways used - new molecular entities (NMEs)

Medicaid

IngenioRx introduces new pharmacy network in 2021

Pharmacy

It is almost CAHPS survey time!

Administrative

Keep up with Medicare news - January 2021

View these Medicare articles:
- Medicare Advantage Group Retiree Quick Reference Guide and FAQ
- Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ
- SNF admission reporting requirements for D-SNP plans
- Policy Update: Nurse Practitioner and Physician Assistant Services – Professional
- Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines
Medicare

MCG Care Guidelines 24th Edition Customization*

Medical Policy & Clinical Guidelines

Medicaid News - January 2021

View these Medicaid articles:
- August 2020 Medical Policies and Utilization Management Guidelines update
- Independent laboratory provider – Place of service 81
- New specialty pharmacy medical step therapy requirements
- Prior authorization requirements for Moderate to Deep Anesthesia for Dental Surgery in the Facility Setting
- Policy Update: Nurse Practitioner and Physician Assistant Services
- Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines
Medicaid

Medical drug benefit clinical criteria updates

Medicaid

Medical drug benefit clinical criteria updates

Medicare

Medical Policy and Clinical Guideline Updates - January 2021*

Medical Policy & Clinical Guidelines

New features added to Interactive Care Reviewer

Administrative

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

Outpatient system updates for 2021 - Facility

Administrative

Prior authorization updates for specialty pharmacy are available - January 2021*

Pharmacy

Procedure searches in Find Care: New sort option

Administrative

Professional system updates for 2021

Administrative

Reimbursement policy update: Frequency editing - Professional*

Reimbursement Policies

Reimbursement policy update: Guidelines for reporting timed units for physical medicine and rehabilitation - Professional*

Reimbursement Policies

Reimbursement policy update: Modifier Rules - Professional*

Reimbursement Policies

Reimbursement policy update: Multiple diagnostic imaging procedures - Professional*

Reimbursement Policies

Reimbursement policy update: Unit frequency maximum for drugs and biologicals - Professional*

Reimbursement Policies

Self-service, digital transactions are fast and easy

Administrative

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

Medicaid

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

Medicare

Updates to AIM Specialty Health Cardiac clinical appropriateness guidelines

Medicare
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