Wisconsin
Provider Communications

Provider Spotlight

Jun 9, 2021

Information from Anthem for Care Providers about COVID-19 (updated June 9, 2021)

We recently updated information about coverage and cost shares for telephonic-only care.

May 4, 2021

RETRACTION: AIM Rehabilitative program - initial evaluations and site of service reviews


Articles Recent

Title Publication Category Date

Information from Anthem for Care Providers about COVID-19 (updated June 9, 2021)

We recently updated information about coverage and cost shares for telephonic-only care.
COVID-19 Information - Wisconsin Administrative Jun 9, 2021

Updates for specialty pharmacy are available - June 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Pharmacy Jun 1, 2021

Keep your contact information current

June 2021 Anthem Provider News - Wisconsin Administrative Jun 1, 2021

Medical policy and clinical guideline updates - June 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Prior authorization for genetic testing medical policy effective September 1, 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM advanced imaging clinical appropriateness guidelines*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM musculoskeletal program clinical appropriateness guidelines*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Update to evaluation and management services correct coding - Professional

June 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jun 1, 2021

DEXA bone scan criteria for the Federal Employee Program®

June 2021 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Jun 1, 2021

Medicaid News - June 2021

View these Medicaid articles:
- Medical drug benefit Clinical Criteria updates
- Updates to the AIM Advanced Imaging clinical appropriateness guidelines
June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

Provider education program survey: Your Voice Counts

June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

MCG Care Guidelines 25th Edition

June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

Keeping up with routine vaccination during COVID-19

June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

Aspire Health for members in need of palliative care

June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

Complex case management program

June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

Important information about utilization management

June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

Members’ Rights and Responsibilities Statement

June 2021 Anthem Provider News - Wisconsin Medicaid Jun 1, 2021

Let’s vaccinate

June 2021 Anthem Provider News - Wisconsin Products & Programs Jun 1, 2021

Designated specialty pharmacy network updates

June 2021 Anthem Provider News - Wisconsin Pharmacy Jun 1, 2021

Pharmacy information available at anthem.com

June 2021 Anthem Provider News - Wisconsin Pharmacy Jun 1, 2021

Answering your claims questions is easier through chat; secure messaging will sunset soon, start using chat now

June 2021 Anthem Provider News - Wisconsin Administrative Jun 1, 2021

Regular check-ins with your clearinghouse could affect timely filing

June 2021 Anthem Provider News - Wisconsin Administrative Jun 1, 2021

Physicians and clinical care teams: Imaging for lower back pain does not improve outcomes, study finds

June 2021 Anthem Provider News - Wisconsin Administrative Jun 1, 2021

Interactive Care Reviewer’s new copy feature decreases time to submit authorization request

June 2021 Anthem Provider News - Wisconsin Digital Tools Jun 1, 2021

Submit EDI corrected claims via Availity or EDI

June 2021 Anthem Provider News - Wisconsin Digital Tools Jun 1, 2021

Digital solution options with Availity

June 2021 Anthem Provider News - Wisconsin Digital Tools Jun 1, 2021

Two great learning resources on one secure portal

June 2021 Anthem Provider News - Wisconsin Digital Tools Jun 1, 2021

Reimbursement policy update: Outpatient facility claim edits

June 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jun 1, 2021

Medicare News - June 2021

View these Medicare articles:
- Anthem working with Optum to collect medical records for risk adjustment
- Medical drug benefit clinical criteria updates
- Updates to the AIM advanced imaging clinical appropriateness guidelines
June 2021 Anthem Provider News - Wisconsin Medicare Jun 1, 2021

Medical policies and clinical utilization management guidelines update

June 2021 Anthem Provider News - Wisconsin Medicare Jun 1, 2021

Reminders for Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ

June 2021 Anthem Provider News - Wisconsin Medicare Jun 1, 2021

Reimbursement policy reminder: Inpatient readmissions

June 2021 Anthem Provider News - Wisconsin Medicare Jun 1, 2021

Register for upcoming CME webinars

Join us in a new CME webinar series as we share practices and success stories to overcoming barriers in achieving clinical quality goals, attaining better patient outcomes and improving Stars ratings.

5 Strategies to Improve Your Quality Measures - June 10th, 12 p.m. or 3 p.m. ET
7 Ways to Enhance Your Patients’ Experience - June 17th, 12 p.m. or 3 p.m. ET

Register now!


Clinical Quality CME Webinar Series - Wisconsin Administrative May 27, 2021

Register today for the In Pursuit of Racial Equity: Deconstructing Bias forum hosted by Anthem and Motivo on June 9, 2021

Join us to hear from a diverse panel of experienced Motivo and Anthem professionals about racial equity and implicit bias.
Deconstructing Bias Forum Invitation - Wisconsin Administrative May 21, 2021

RETRACTION: AIM Rehabilitative program - initial evaluations and site of service reviews

June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 4, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - May 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.
May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

Specialty pharmacy prior authorization update - Certain drugs for treatment of ocular conditions continue to require prior authorization*

*Material Adverse Change (MAC)
May 2021 Anthem Provider News - Wisconsin Pharmacy May 1, 2021

Updates for specialty pharmacy are available - May 2021*

*Material Adverse Change (MAC)
May 2021 Anthem Provider News - Wisconsin Pharmacy May 1, 2021

Updated 2021 Provider Manual now available

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

Resources to support diverse patients and communities

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

Referring to network DME providers for negative pressure wound therapy helps members save on out-of-pocket costs

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

2021 Affirmative statement regarding utilization management decisions

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

A helpful and complete guide to covered well-child visits

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

May is National High Blood Pressure Education Month

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

Digital online scheduling feature now available in the Availity Portal

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

Provider bulletins for medical and itemized bill attachments: Electronic solutions at your fingertips

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

Sending larger digital attachments through Availity

May 2021 Anthem Provider News - Wisconsin Administrative May 1, 2021

New prior authorization requirement: Kidney transplantation*

*Material Adverse Change (MAC)
May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines

May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Updated AIM rehabilitative program effective August 1, 2021 - Initial evaluations and site of service reviews RETRACTION - Please refer to article published May 4, 2021

May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation - Facility*

*Material Adverse Change (MAC)
May 2021 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2021

Reimbursement policy reminder: Readmission - Facility

May 2021 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2021

Reimbursement policy update: Frequency editing - Professional

May 2021 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2021

Medicaid news - May 2021

View these Medicaid articles:
- Maximizing efficient, high quality COVID-19 screenings
- Updates to the AIM Specialty Health Musculoskeletal Program Clinical Appropriateness Guidelines
May 2021 Anthem Provider News - Wisconsin Medicaid May 1, 2021

Metabolic monitoring and diabetes screening measures for those on antipsychotics medications

May 2021 Anthem Provider News - Wisconsin Medicaid May 1, 2021

Aspire Health telehealth palliative care program for Medicaid members in need of telephonic palliative care

May 2021 Anthem Provider News - Wisconsin Medicaid May 1, 2021

Maximizing efficient, high quality COVID-19 screenings

May 2021 Anthem Provider News - Wisconsin Medicare May 1, 2021

Retraction: AIM Rehabilitative program - initial evaluations and site of service reviews

May 2021 Anthem Provider News - Wisconsin Medicaid May 1, 2021

Reimbursement policy update: Multiple and bilateral surgery - Professional and Facility

May 2021 Anthem Provider News - Wisconsin Medicaid May 1, 2021

Continuing medical education and continuing education unit opportunities

May 2021 Anthem Provider News - Wisconsin Medicaid May 1, 2021

Sign up to receive email from Anthem Blue Cross and Blue Shield

May 2021 Anthem Provider News - Wisconsin Medicaid May 1, 2021

Keep up with Medicare news - May 2021

View these Medicare articles:
- Anthem working with Optum to collect medical records for Medicare Risk Adjustment (MRA)
- Helping our senior members
- Updates to the AIM Specialty Health musculoskeletal Program clinical appropriateness guidelines
May 2021 Anthem Provider News - Wisconsin Medicare May 1, 2021

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.
April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

The health of millennials: Trends in behavioral health conditions

April 2021 Anthem Provider News - Wisconsin Behavioral Health Apr 1, 2021

Designated specialty pharmacy network*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Pharmacy Apr 1, 2021

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

April 2021 Anthem Provider News - Wisconsin Pharmacy Apr 1, 2021

Updates for specialty pharmacy are available - April 2021*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Pharmacy Apr 1, 2021

Pharmacy information available at anthem.com

April 2021 Anthem Provider News - Wisconsin Pharmacy Apr 1, 2021

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

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Does your practice offer telehealth services? Let us know!

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Information Center - Access important policies, forms and helpful resources

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Understanding Availity roles for electronic data interchange (EDI)

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

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

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

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

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Chat directly with a prior authorization specialist

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Keeping up with routine vaccination during COVID-19

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Interactive bilingual website taking action for our health

Exclusively developed for the Latino Community
April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Join Anthem in talking about racism and its impact on health

April 2021 Anthem Provider News - Wisconsin Administrative Apr 1, 2021

Medical policy and clinical guideline updates - April 2021*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

Update: Clinical guideline adoption postponed*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

MCG Care Guidelines 25th Edition available*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

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

April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

Maximizing efficient, high quality COVID-19 screenings*

*Material Adverse Change (MAC)
COVID-19 Information - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

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

April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

HEDIS 2021 Federal Employee Program® medical record request requirements

April 2021 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Apr 1, 2021

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
April 2021 Anthem Provider News - Wisconsin Medicaid Apr 1, 2021

Does your practice offer telehealth services? Let us know!

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

In-Office Assessment program

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Oncology dose reduction program beginning July 1, 2021

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Clinical criteria updates notification - November 2020

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Clinical criteria updates notification - December 2020

April 2021 Anthem Provider News - Wisconsin Medicare Apr 1, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - March 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.
March 2021 Anthem Provider News - Wisconsin Administrative Mar 1, 2021

Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021*

*Material Adverse Change (MAC)
March 2021 Anthem Provider News - Wisconsin Pharmacy Mar 1, 2021

Updates for specialty pharmacy are available - March 2021*

*Material Adverse Change (MAC)
March 2021 Anthem Provider News - Wisconsin Pharmacy Mar 1, 2021

Some HIV medication combinations may require prior authorization

March 2021 Anthem Provider News - Wisconsin Pharmacy Mar 1, 2021

Medical attachment capability now includes itemized bills and more!

March 2021 Anthem Provider News - Wisconsin Administrative Mar 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery guideline

March 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Mar 1, 2021

Claims editing update for ICD-10-CM Excludes 1 notes

March 2021 Anthem Provider News - Wisconsin Reimbursement Policies Mar 1, 2021

Access to more claim denial information is now self-service

March 2021 Anthem Provider News - Wisconsin Medicaid Mar 1, 2021
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