Wisconsin
Provider Communications

Provider Spotlight

Oct 19, 2021

New Medicare Advantage plan will have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing providers nationally

Effective January 1, 2022, approximately 240,000 Medicare-eligible City of New York retirees across the United States will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan and have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing. Read important information about this change in the New York City Medicare Advantage announcement.

Oct 1, 2021

Important COVID-19 update: Prior authorization and other policy adjustments (Updated October 1, 2021)

We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities.


Articles Recent

Title Publication Category Date

New Medicare Advantage plan will have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing providers nationally

Effective January 1, 2022, approximately 240,000 Medicare-eligible City of New York retirees across the United States will transition to Retiree Health Alliance’s NYC Medicare Advantage Plus plan and have access to BlueCross BlueShield Medicare Advantage PPO Network Sharing. Read important information about this change in the New York City Medicare Advantage announcement.

N/A Medicare Oct 19, 2021

Join the American Heart Association for a CME webinar on hypertension and diabetes disease management


Chronic disease management strategies for your patients with hypertension and diabetes

Date: Friday, October 8, 2021

Time: 12:00 p.m. ET

Clinical Quality CME Webinar Series Continues - Wisconsin Administrative Oct 5, 2021

Important COVID-19 update: Prior authorization and other policy adjustments (Updated October 1, 2021)

We recently updated prior authorization requirements for patient transfers from acute inpatient hospitals to skilled nursing facilities.
COVID-19 Information - Wisconsin Administrative Oct 1, 2021

Clarification: Anthem’s enhanced claim edits for outpatient facility claims

October 2021 Anthem Provider News - Wisconsin Administrative Oct 1, 2021

New BlueHPN network plans available for employee open enrollment Fall 2021

October 2021 Anthem Provider News - Wisconsin Products & Programs Oct 1, 2021

Specialty pharmacy updates are available - October 2021*

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

Designated specialty pharmacy network updates effective January 1, 2022*

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

Medical policy and clinical guideline updates - October 2021*

*Material Adverse Change (MAC)

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

Continuation of skilled nursing facility (SNF) program in Wisconsin

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

Reimbursement policy clarification: Claims requiring additional documentation - Facility

October 2021 Anthem Provider News - Wisconsin Reimbursement Policies Oct 1, 2021

Keep up with Medicaid News - October 2021

View these Medicaid articles:
- 2021 affirmative statement concerning utilization management decisions
- May 2021 medical policies and utilization management guidelines update
October 2021 Anthem Provider News - Wisconsin Medicaid Oct 1, 2021

Diabetes testing and screening HEDIS measures

October 2021 Anthem Provider News - Wisconsin Medicaid Oct 1, 2021

Get your payments faster when you sign up for electronic funds transfer

October 2021 Anthem Provider News - Wisconsin Medicaid Oct 1, 2021

New reimbursement policy: Sexually transmitted infections testing (Professional)

October 2021 Anthem Provider News - Wisconsin Medicaid Oct 1, 2021

Prior authorization updates for specialty pharmacy

October 2021 Anthem Provider News - Wisconsin Medicaid Oct 1, 2021

Get your payments faster when you sign up for electronic funds transfer

October 2021 Anthem Provider News - Wisconsin Medicare Oct 1, 2021

Keep up with Medicare news - October 2021

View these Medicare articles:
- 2021 affirmative statement concerning utilization management decisions
- May 2021 Medical Policies and Utilization Management Guidelines update
October 2021 Anthem Provider News - Wisconsin Medicare Oct 1, 2021

Looking to earn CME credits? Register for these on-demand webinars!

October 2021 Anthem Provider News - Wisconsin Administrative Oct 1, 2021

Federal Price Transparency and Consolidated Appropriations Act phase in new mandates beginning January 1, 2022

October 2021 Anthem Provider News - Wisconsin Administrative Oct 1, 2021

Your recommendation is key to encouraging cancer screenings for your female patients

October 2021 Anthem Provider News - Wisconsin Administrative Oct 1, 2021

Are you talking to ALL of your patients about breast cancer screenings?

October 2021 Anthem Provider News - Wisconsin Administrative Oct 1, 2021

Good news! Non-payment remittance advice enhancements coming soon

October 2021 Anthem Provider News - Wisconsin Administrative Oct 1, 2021

Clinical appeals

October 2021 Anthem Provider News - Wisconsin Administrative Oct 1, 2021

Reminder: EnrollSafe, the new EFT enrollment portal for Anthem providers replacing CAQH Enrollhub effective November 1, 2021

October 2021 Anthem Provider News - Wisconsin Digital Tools Oct 1, 2021

Procedure searches in Find Care

October 2021 Anthem Provider News - Wisconsin Digital Tools Oct 1, 2021

Pharmacy information available at anthem.com

October 2021 Anthem Provider News - Wisconsin Pharmacy Oct 1, 2021

New reimbursement policy: Sexually transmitted infections testing (Professional)

October 2021 Anthem Provider News - Wisconsin Medicare Oct 1, 2021

Information about 2021 Special Needs Plans

October 2021 Anthem Provider News - Wisconsin Medicare Oct 1, 2021

HEDIS medical record submission made easier with our Remote EMR Access Service

October 2021 Anthem Provider News - Wisconsin Medicare Oct 1, 2021

New medical step therapy requirements

October 2021 Anthem Provider News - Wisconsin Medicare Oct 1, 2021

Register today for the Exploring the Impact of Racial Trauma on the Health & Wellbeing of Children forum on September 29, 2021

Join us to hear from a diverse panel of experienced Motivo and Anthem professionals about the impact of racial trauma on the health and wellbeing on children and adolescents
Racial Trauma & Children - Wisconsin Administrative Sep 15, 2021

Updates for specialty pharmacy are available - September 2021*

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

Reimbursement policy update: Sexually transmitted infections testing - Professional*

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

New reimbursement policy update: Inpatient Facility Transfers - Facility*

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

Reimbursement policy update: Drug Screen Testing - Professional*

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

Keep up with Medicaid news  - September 2021

View these Medicaid articles:
- Clinical Criteria Updates Notification – May 2021
- CT to detect coronary artery calcification — AIM transition
September 2021 Anthem Provider News - Wisconsin Medicaid Sep 1, 2021

National Accounts 2022 Pre-certification list

September 2021 Anthem Provider News - Wisconsin Administrative Sep 1, 2021

Register now for our September CME webinars

September 2021 Anthem Provider News - Wisconsin Administrative Sep 1, 2021

Statin therapy for patients with diabetes

September 2021 Anthem Provider News - Wisconsin Administrative Sep 1, 2021

Six SIMPLE strategies to help increase medication adherence

September 2021 Anthem Provider News - Wisconsin Administrative Sep 1, 2021

Cure for the common cold: Rest, fluids and this free prescription pad

September 2021 Anthem Provider News - Wisconsin Administrative Sep 1, 2021

HEDIS® medical record submission made easier with our Remote EMR Access Service

September 2021 Anthem Provider News - Wisconsin Administrative Sep 1, 2021

Get your payments faster when you sign up for electronic funds transfer

Introducing EnrollSafe, the new electronic funds transfer enrollment portal for Anthem providers – replacing CAQH Enrollhub effective November 1, 2021.
September 2021 Anthem Provider News - Wisconsin Digital Tools Sep 1, 2021

Keep up with Medicare news - September 2021

View this Medicare article:
- Clinical criteria updates notification – May 2021

 

September 2021 Anthem Provider News - Wisconsin Medicare Sep 1, 2021

Reimbursement Policy Update: DRG Inpatient Facility Transfers

September 2021 Anthem Provider News - Wisconsin Medicare Sep 1, 2021

Utilization management authorization rule operations

September 2021 Anthem Provider News - Wisconsin Medicare Sep 1, 2021

Prior authorization form notification

September 2021 Anthem Provider News - Wisconsin Medicare Sep 1, 2021

Information from Anthem for Care Providers about COVID-19 (updated August 2, 2021)

We recently updated information about coverage dates for telephonic-only care.
COVID-19 Information - Wisconsin Administrative Aug 2, 2021

Register now for our August CME webinars

August 2021 Anthem Provider News - Wisconsin Administrative Aug 1, 2021

Telehealth visits can impact after hospitalization follow-up care for mental illness

August 2021 Anthem Provider News - Wisconsin Administrative Aug 1, 2021

Clearing up coding confusion for retinal eye exams (DRE)

August 2021 Anthem Provider News - Wisconsin Administrative Aug 1, 2021

New! Schedule appointments online through Availity

August 2021 Anthem Provider News - Wisconsin Digital Tools Aug 1, 2021

Anthem to update formulary lists for commercial health plan pharmacy benefit effective October 1, 2021*

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

Updates for specialty pharmacy are available - August 2021*

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

Specialty dose rounding program for certain oncology medications

August 2021 Anthem Provider News - Wisconsin Pharmacy Aug 1, 2021

Specialty dose rounding program for certain non-oncology medications beginning August 1, 2021

August 2021 Anthem Provider News - Wisconsin Pharmacy Aug 1, 2021

Immune globulin adjusted body weight dosing program beginning August 1, 2021

August 2021 Anthem Provider News - Wisconsin Pharmacy Aug 1, 2021

Pharmacy information available at anthem.com

August 2021 Anthem Provider News - Wisconsin Pharmacy Aug 1, 2021

Transition to AIM Specialty Health imaging of the heart clinical appropriateness guideline for computed tomography to detect coronary artery calcification

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

Reimbursement policy update: Virtual Visits (Professional and Facility)*

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

Reimbursement policy update: Claims requiring additional documentation (Facility)*

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

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, & XU*

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

Change in email submission of service requests for Federal Employee Program® members*

*Material Adverse Change (MAC)
August 2021 Anthem Provider News - Wisconsin Federal Employee Plan (FEP) Aug 1, 2021

Medicaid News - August 2021

View these Medicaid articles:
-Iron Infusion Step Therapy
-Prior authorization requirement changes effective September 1, 2021 – UM AROW 1837
-Iron Infusion Prior Authorization Update
August 2021 Anthem Provider News - Wisconsin Medicaid Aug 1, 2021

Medicare News - August 2021

View these Medicare articles:
- Infliximab Step Therapy - Effective 7/15/2021
- Prior authorization requirement changes effective October 1, 2021 – UM AROW 1907
August 2021 Anthem Provider News - Wisconsin Medicare Aug 1, 2021

Preventing claims denials: Shingles vaccine

August 2021 Anthem Provider News - Wisconsin Medicare Aug 1, 2021

Register for upcoming August 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.

Motivating Patients to Adhere to Cervical Cancer Prevention and Screening Recommendations
Tuesday, August 3, 2021, 12:00 p.m. ET

10 Best Practices for Improving Pharmacy Quality Measures
Thursday, August 12, 2021, 1:00 p.m. or 3:00 p.m. ET

6 Ways to Improve Risk Adjustment Documentation Accuracy
Tuesday, August 17, 2021, 12:00 p.m. or 3:00 p.m. ET

Register Now!

Clinical Quality CME Webinar Series Continues - Wisconsin Administrative Jul 29, 2021

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

July 2021 Anthem Provider News - Wisconsin Administrative Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Administrative Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Administrative Jul 1, 2021

Another mark of the pandemic: An increase in childhood obesity

July 2021 Anthem Provider News - Wisconsin Administrative Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Digital Tools Jul 1, 2021

Electronic claim response files

July 2021 Anthem Provider News - Wisconsin Digital Tools Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Digital Tools Jul 1, 2021

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

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

Designated specialty pharmacy network updates effective October 1, 2021*

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

Updates for specialty pharmacy are available - July 2021*

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

Certain specialty medication prior authorization requests may require additional documentation*

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

Medical Policy and Clinical Guideline Updates - July 2021*

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

Reimbursement policy update: Consultations - Professional*

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

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
July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

Let’s Vaccinate

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

What Matters Most: Improving the patient experience

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

Resources to support your diverse patient panel

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

Coding spotlight: Mental disorders in childhood

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

March 2021 medical drug benefit clinical criteria updates

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

Prior authorization requirement changes effective September 1, 2021

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

Updates to AIM Specialty Health Musculoskeletal Program clinical appropriateness guidelines

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Medicaid Jul 1, 2021

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
July 2021 Anthem Provider News - Wisconsin Medicare Jul 1, 2021

Let’s Vaccinate

July 2021 Anthem Provider News - Wisconsin Medicare Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Medicare Jul 1, 2021

Medical drug benefit clinical criteria updates

July 2021 Anthem Provider News - Wisconsin Medicare Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Medicare Jul 1, 2021

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

July 2021 Anthem Provider News - Wisconsin Medicare Jul 1, 2021

Voluntary recall of Philips Respironics CPAP machine, BiPAP machine, and ventilators

Voluntary recall of Philips Respironics CPAP machine, BiPAP machine, and ventilators Administrative Jun 25, 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
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