Wisconsin
Provider Communications

Provider Spotlight

Jan 13, 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.

Jan 8, 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.

Jan 1, 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.


Articles Recent

Title Publication Category Date

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

Information from Anthem for Care Providers about COVID-19 (Updated December 30, 2020)

We’ve updated information about cost share waivers for COVID-19 treatment as well as cost share information for telehealth and telephonic-only care.
COVID-19 Information - Wisconsin Administrative Dec 30, 2020

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

Notifications on the Availity Portal

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

Resources to support your pregnant and postpartum patients and their families

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

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

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

Digital transactions cut administrative tasks in half

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

Transition to AIM small joint guidelines

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

Access requirements for behavioral health care services

December 2020 Anthem Provider News - Wisconsin Behavioral Health Dec 1, 2020

Prior authorization updates for specialty pharmacy are available - December 2020*

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

AIM IVR changes for non-oncology medical specialty drug reviews effective Jan. 1, 2021

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

Pharmacy information available at anthem.com

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

Access to claim denial information is now self-service

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

2-minute videos to engage patients about preventive care

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

Anthem makes going digital easy with the Provider Digital Engagement Supplement

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

PCP after-hours access requirements

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

Coordination of care

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

Members’ rights and responsibilities

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

Important information about utilization management

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

Case management program

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

Medical policy and clinical guideline updates - December 2020*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Anthem expands hospice policy

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Cardiology clinical appropriateness guidelines*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Advanced Imaging clinical appropriateness guideline*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Radiation Oncology clinical appropriateness guideline*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Transition to AIM Rehabilitative Services clinical appropriateness guidelines

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Clinical practice and preventive health guidelines available on anthem.com

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Reimbursement policy update: Bundled services and supplies (Professional)*

December 2020 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2020

Reimbursement policy update: DRG newborn inpatient stays (Facility)*

December 2020 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2020

2021 Medicare Advantage individual benefits and formularies

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

Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ

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

Medical policies and clinical utilization management guidelines update

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

Policy Update: Emergency Department: Leveling of Evaluation and Management Services

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

Digital transactions cut administrative tasks in half

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

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - November 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.
November 2020 Anthem Provider News - Wisconsin Administrative Nov 1, 2020

IngenioRx Introduces new pharmacy network in 2021

November 2020 Anthem Provider News - Wisconsin Pharmacy Nov 1, 2020

Prior authorization updates for specialty pharmacy are available - November 2020*

November 2020 Anthem Provider News - Wisconsin Pharmacy Nov 1, 2020

Availity attachment tools for Anthem and affiliate payers - Live Webinars

Sign up for upcoming webinars!
November 2020 Anthem Provider News - Wisconsin Administrative Nov 1, 2020

Clinical Laboratory Improvement Amendments (CLIA) Number - Additional Information

November 2020 Anthem Provider News - Wisconsin Administrative Nov 1, 2020

Digital transactions cut administrative tasks in half

November 2020 Anthem Provider News - Wisconsin Administrative Nov 1, 2020

Get the full picture of your patient’s health through their smartphone

November 2020 Anthem Provider News - Wisconsin Administrative Nov 1, 2020

US Antibiotic Awareness Week

November 2020 Anthem Provider News - Wisconsin Administrative Nov 1, 2020

Medical policy and clinical guideline updates - November 2020*

November 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2020

Correction to Prior Authorization Update for Commercial business*

November 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2020

Reminder: Post-service reviews using AIM

November 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2020

New reimbursement policy: Documentation standards for episodes of care (Professional)*

November 2020 Anthem Provider News - Wisconsin Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Modifier rules (Professional)*

November 2020 Anthem Provider News - Wisconsin Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Bundled services and supplies (Professional)*

November 2020 Anthem Provider News - Wisconsin Reimbursement Policies Nov 1, 2020

Medicaid News - November 2020

View these Medicaid article:
- Evaluation and management services correct coding
- New specialty pharmacy medical step therapy requirements
- Provider Chat: A fast, easy way to get your questions answered
- New specialty pharmacy medical step therapy requirements
- Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations
- Electronic visit verification notification
November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Digital transactions cut administrative tasks in half

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Medical drug benefit clinical criteria updates

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Prior authorization requirements for HCPCS code 55899

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Medicare News - November 2020

View these Medicare articles:
- AIM rehabilitation prior authorizations suspended for Group Retiree Solutions members until December 31, 2020
- Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines
- AIM Musculoskeletal program expansion postponed
November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Inhaled nitric oxide reviews for diagnosis-related group admissions

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Transition to AIM Rehabilitative Service Clinical Appropriateness Guidelines

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Provider Chat: A fast, easy way to get your questions answered

November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Provider transparency update

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

Digital transactions cut administrative tasks in half

November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Coding spotlight: Tips and best practices for compliance

November 2020 Anthem Provider News - Wisconsin Medicaid Nov 1, 2020

FDA approvals and expedited pathways used - new molecular entities

November 2020 Anthem Provider News - Wisconsin Medicare Nov 1, 2020

Register today for a Racial Trauma Forum hosted by Anthem and Motivo on October 28, 2020

Racial Trauma Forum invitation - Wisconsin Behavioral Health Oct 14, 2020

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - October 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.
October 2020 Anthem Provider News - Wisconsin Administrative Oct 1, 2020

New Blue HPN® network included in plans available for employee open enrollment Fall 2020

October 2020 Anthem Provider News - Wisconsin Products & Programs Oct 1, 2020

Anthem updates formulary lists for commercial health plan pharmacy benefit

October 2020 Anthem Provider News - Wisconsin Pharmacy Oct 1, 2020
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