Wisconsin
Provider Communications
Updated Provider Manual now available
There were changes to the following sections in 2019 (listed in alphabetical order):
New content
- Claim Payment Disputes
- Clinical Appeals
- Medical Records Submission
Updated content
- General
- Navigation directions from anthem.com to public provider website.
- AIM Specialty Health® (AIM)
- Updated microsite information
- Availity Portal
- Updated information on Anthem functionality
- Centers of Medical Excellence
- New program (Chimeric Antigen Receptor Therapy (“CAR-T”))
- Claim Filing and Provider Correspondence Filing Tips
- Enhanced information for claim and adjustment filing
- Itemized Bills section added
- Maternity Delivery Claims section added
- Credentialing
- Clarification to II.A.13 initial credentialing scope and HDO acceptable accrediting agencies
- Electronic Data Interchange (EDI) Overview
- Information on Availity as Anthem’s designated EDI Gateway
- Fraud, Waste and Abuse Detection
- Clarification in Pre-Payment Review section
- Medical Policy
- Statement added to further define services
- Member Quality of Care (“QOC”)/Quality of Service (“QOS”) Investigations
- Content added to remind providers on contractual obligation related to the investigations.
- Multicultural Health
- Update to Medication Adherence CME course added
- Reimbursement Guidelines and Policies
- Facility Personnel Charges - Clarification of examples not separately reimbursed
- Implants – Added requirement for itemization of all implant kits that contain procedure tools or medical supplies
- Lab Charges section added
- Routine Supplies section added
- Special Procedure Room Charge – Clarified where procedure takes place
- Supplies and Equipment section added
- Tech Support Charges section added
- Tests or Procedures Prior to Admission(s) or Outpatient Services – Clarifying statement added for testing timeframe
- Additional Reimbursement Guidelines for Disallowed Charges section added
- Utilization Management
- Definitions in alphabetical order
- Program overview section added
- Preservice and Continued Stay Review communication and timeframe added
The 2018 Wisconsin Provider Manual will also be available until July 1, 2019.
Featured In:
May 2019 Anthem Provider Newsletter - Wisconsin