Wisconsin
Provider Communications

Provider Spotlight

Apr 6, 2021

Information from Anthem for Care Providers about COVID-19 (updated April 6, 2021)

We recently updated information about reimbursement for the COVID-19 vaccine.

Apr 1, 2021

Maximizing efficient, high quality COVID-19 screenings*

*Material Adverse Change (MAC)

Apr 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.


Articles Recent

Title Publication Category Date

Information from Anthem for Care Providers about COVID-19 (updated April 6, 2021)

We recently updated information about reimbursement for the COVID-19 vaccine.
COVID-19 Information - Wisconsin Administrative Apr 6, 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

MCG Care Guidelines 24th edition customization

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

Updated AIM Rehabilitative program effective August 1, 2021 - Site of Care reviews

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

Coding spotlight: Overview of the 2021 evaluation and management changes

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

Medicare News - March 2021

View these Medicare articles:
- MCG Care Guidelines 24th edition customization
- DME checklist of information needed from providers
March 2021 Anthem Provider News - Wisconsin Medicare Mar 1, 2021

New provider directory indicator for telehealth services

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

Medical policies and clinical utilization management guidelines update

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

Access to more claim denial information is now self-service

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

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

Anthem to update formulary lists for commercial health plan pharmacy benefit

February 2021 Anthem Provider News - Wisconsin Pharmacy Feb 1, 2021

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

February 2021 Anthem Provider News - Wisconsin Pharmacy Feb 1, 2021

Pharmacy information available at anthem.com

February 2021 Anthem Provider News - Wisconsin Pharmacy Feb 1, 2021

New provider directory indicator for telehealth services

February 2021 Anthem Provider News - Wisconsin Administrative Feb 1, 2021

New Anthem utilization management tool now available on Availity: Authorization Rules Lookup tool

February 2021 Anthem Provider News - Wisconsin Administrative Feb 1, 2021

Medical Policy and Clinical Guideline Updates - February 2021*

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

Reimbursement policy update: Emergency Room Transfers - Facility*

February 2021 Anthem Provider News - Wisconsin Reimbursement Policies Feb 1, 2021

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility*

February 2021 Anthem Provider News - Wisconsin Reimbursement Policies Feb 1, 2021

Medicaid News - February 2021

View these Medicaid articles:
- Delay of AIM Musculoskeletal Program guideline updates for Medicaid
- New specialty pharmacy medical step therapy requirements
- Provider notification for Utilization Management Authorization Rule Operations Workgroup Item 1326
February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

Availity Portal eligibility and benefits provides both additional benefit notes and digital member ID Cards

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

Medical drug benefit clinical criteria updates - February 2021

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

CAHPS® survey

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

HEDIS Measurement Year 2020: Medicaid summary of changes from NCQA

February 2021 Anthem Provider News - Wisconsin Medicaid Feb 1, 2021

PN for UM AROW Item 1330

February 2021 Anthem Provider News - Wisconsin Medicare Feb 1, 2021

Medical drug benefit clinical criteria updates - February 2021

February 2021 Anthem Provider News - Wisconsin Medicare Feb 1, 2021

Register today for The Road to Allyship Forum hosted by Anthem and Motivo on February 3, 2021

Join us to hear from a diverse panel of experienced Motivo and Anthem professionals about racial equity and the importance of allies.
The Road to Allyship Forum Invitation Administrative Jan 21, 2021

Important COVID-19 update: Prior authorization and other policy adjustments (Updated January 13, 2021)

Prior authorization requirements updated for patient transfers from acute inpatient hospitals to skilled nursing facilities.
COVID-19 Information - Wisconsin Administrative Jan 13, 2021

COVID-19 Update: Guidance for telehealth/telephonic care for Behavioral Health services (Updated January 8, 2021)

We’ve updated information about coverage for telephonic-only care.
COVID-19 Information - Wisconsin Administrative Jan 8, 2021

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.
January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

IngenioRx introduces new pharmacy network in 2021

January 2021 Anthem Provider News - Wisconsin Pharmacy Jan 1, 2021

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

January 2021 Anthem Provider News - Wisconsin Pharmacy Jan 1, 2021

It is almost CAHPS survey time!

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

Evaluation and management changes 2021

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

Outpatient system updates for 2021 - Facility

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

Professional system updates for 2021

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

New features added to Interactive Care Reviewer

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

Procedure searches in Find Care: New sort option

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

Availity attachment tools for Anthem and affiliate payers - Live webinars

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

Self-service, digital transactions are fast and easy

January 2021 Anthem Provider News - Wisconsin Administrative Jan 1, 2021

Medical Policy and Clinical Guideline Updates - January 2021*

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

MCG Care Guidelines 24th Edition Customization*

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

Reimbursement policy update: Multiple diagnostic imaging procedures - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Frequency editing - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

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

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Modifier Rules - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

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

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

2021 FEP® benefit information available online

January 2021 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Jan 1, 2021

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
January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

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

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Medical drug benefit clinical criteria updates

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Disease Management/Population Health program

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

Coding spotlight: HEDIS MY 2021

January 2021 Anthem Provider News - Wisconsin Medicaid Jan 1, 2021

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
January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

2020 Medicare risk adjustment provider trainings

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Updates to AIM Specialty Health Cardiac clinical appropriateness guidelines

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Medical drug benefit clinical criteria updates

January 2021 Anthem Provider News - Wisconsin Medicare Jan 1, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - December 2020

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.
December 2020 Anthem Provider News - Wisconsin Administrative Dec 1, 2020

Plans accessing new Blue HPN® network go live Jan. 1, 2021

December 2020 Anthem Provider News - Wisconsin Administrative Dec 1, 2020

Updated BlueCard® Program Provider Manual available Jan. 1, 2021

December 2020 Anthem Provider News - Wisconsin Administrative Dec 1, 2020

Anthem contracted air ambulance providers for Wisconsin

December 2020 Anthem Provider News - Wisconsin Administrative Dec 1, 2020

Medicaid News - December 2020

View these Medicaid article:
- Anti-VEGF Medical Step Therapy Notice
- Important reminder: Coding requirements for reimbursement for early elective deliveries
- Transition to AIM small joint guidelines

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020

CAHPS education for providers

December 2020 Anthem Provider News - Wisconsin Medicaid Dec 1, 2020
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