Anthem Blue Cross and Blue Shield (Anthem) reviews and updates our online provider manual annually.  The updated manual is effective July 1, 2022 and is available now on our public provider website at anthem.com . Select Providers and choose Policies, Guidelines and Manuals under Provider Resources in the horizontal menu.  Select Wisconsin as the state if needed and scroll down to the Provider Manual section.  Select Download the Manual.  Scroll to the Looking for our Upcoming Provider Manual section and select Preview the upcoming manual to view the manual. 

 

There were changes to the following sections listed in alphabetical order:

Updated content
  • AIM Specialty Health® (AIM)
    • Updated Contact Center telephone number
  • Appointment Access and Geographic Availability
    • Behavioral Health Appointment Access for Urgent Care changed to within 24 hours
    • Geographic availability data source changed from GeoAccess® software to Quest Analytics SuiteTM software
  • Availity Portal
    • Updated application capability information
  • Centers of Medical Excellence
    • Update to statistics and Cellular Immunotherapy (Chimeric Antigen Receptor Therapy -“CAR-T”) section
  • Claim Payment Disputes
    • Disputes of Prepayment Itemized Bill Review Findings added under non-clinical claim payment disputes.
  • Clinical Appeals
    • Providers submitting an appeal on behalf of the member may be required to submit a member authorization form added
  • Continuity of Care/Transition of Care Program
    • Added information related to the Federal Consolidations Appropriations Act (CAA)
  • Directory of Services
    • Updated Provider Experience contacts
  • Dispute Resolution and Arbitration
    • Revised language
    • Consolidation and Interest sections added
  • Fraud, Waste and Abuse Detection
    • Additional information for Special Investigations Unit (SIU)
  • Insurance Requirements
    • Content reduced to one paragraph
  • Overview of HEDIS
    • Updated information on data collection
  • Quality Improvement Programs
    • Updates to Program Goals and Objectives
  • Reimbursement Requirements and Policies
    • Supplies related to the use of robotic technology included in operating room charge not eligible for separate reimbursement
    • Routine supplies section shortened
    • Hospital/Technical Anesthesia Component added under Time Calculation
  • Utilization Management
    • Discharge Planning added under UM Definitions.
    • Virtual review added to On-Site Review section.
    • Submit authorization requests digitally via Availity added.
  • Wisconsin Autism Mandate
    • Removed Sensory integration therapy under services not covered
    • Updated links to statutes and regulations

 

The 2021 Wisconsin Provider Manual will also be available until July 1, 2022.

 

2114-0522-PN-WI



Featured In:
May 2022 Anthem Provider News - Wisconsin