Wisconsin
Provider Communications

July 2021 Anthem Provider News - Wisconsin

Download as PDF

Title Category

Another mark of the pandemic: An increase in childhood obesity

Administrative

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

Medicaid

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

Medicare

Certain specialty medication prior authorization requests may require additional documentation*

*Material Adverse Change (MAC)
Pharmacy

Coding spotlight: Mental disorders in childhood

Medicaid

Designated specialty pharmacy network updates effective October 1, 2021*

*Material Adverse Change (MAC)
Pharmacy

Electronic claim response files

Digital Tools

How to enroll in electronic fund transfer (EFT) for faster remittance

Digital Tools

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Digital Tools

Let’s Vaccinate

Medicaid

Let’s Vaccinate

Medicare

March 2021 medical drug benefit clinical criteria updates

Medicaid

Medicaid News - July 2021

View these Medicaid articles:
- Specialty pharmacy prior authorization retraction notice
- Infusion step therapy retraction notice
- Specialty Rx precertification additional documentation notice effective August 1, 2021
- Prior authorization requirement changes effective September 1, 2021–UM AROW 1327
- February 2021 medical policies and utilization management guidelines update
Medicaid

Medical drug benefit clinical criteria updates

Medicare

Medical Policy and Clinical Guideline Updates - July 2021*

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

Medicare News - July 2021

View these Medicare articles:
- Prior authorization requirement changes effective September 1, 2021 – UM Authorization Rule Operations Workgroup (AROW) Item 1845
- Provider notification for UM Authorization Rule Operations Workgroup (AROW) Item 1846
Medicare

New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing

Medicaid

New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing

Medicare

Prior authorization requirement changes effective September 1, 2021

Medicaid

Prior authorization requirement changes effective September 1, 2021 - UM AROW 1837

Medicaid

Prior authorization requirement changes for codes A0426 and A0428 effective October 1, 2021

Medicare

Proper coding for in-home monitoring can make a measurable difference for INR

Administrative

Register now to learn strategies to help you and your practice improve clinical quality

Administrative

Reimbursement policy update: Consultations - Professional*

*Material Adverse Change (MAC)
Reimbursement Policies

Resources to support your diverse patient panel

Medicaid

Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims

Administrative

Update: Site of care medical necessity reviews for long-acting colony-stimulating factors not implemented on June 1, 2021*

*Material Adverse Change (MAC)
Pharmacy

Updates for specialty pharmacy are available - July 2021*

*Material Adverse Change (MAC)
Pharmacy

Updates to AIM Specialty Health Musculoskeletal Program clinical appropriateness guidelines

Medicaid

What Matters Most: Improving the patient experience

Medicaid
Page 1 of 1