Updated 2021 Provider Manual now available

Anthem Blue Cross and Blue Shield (Anthem) reviews and updates our online Provider Manual annually. The updated manual has a new look, is effective July 1, 2021 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. Scroll down to the Provider Manual section and select Download the Manual. Scroll to the Looking for our Upcoming Provider Manual section and select Preview the upcoming manual to view the manual. 

 

Aside from formatting and structure, there were changes to the following sections listed in alphabetical order:

 

New content

• Admission, Discharge and Transfer Data
• Affiliates
• Clinical Data Sharing
• Provider and Facility Digital Engagement

 

Updated content

• AIM Specialty Health_® (AIM)
  • Updated list of services and main microsite
• Audit and Review
  • Updates to clarify audit procedures
• Availity Portal
  • Updated application capabilities
• Centers of Medical Excellence
  • Updated statistics and Cellular Immunotherapy (Chimeric Antigen Receptor Therapy -“CAR-T”) section
• Claim Filing Tips
  • Electronic claim submission content added
• Claim Payment Disputes
  • Added Chat with Payer application
• Clinical Appeals
  • Added direction on where to find Designation of an Authorized Representative (DOR) form online
• Credentialing
  • Summary information – Full content is available on anthem.com
• Culturally and Linguistically Appropriate Services changed from Multicultural Health
• Introduction and Guide to Manual
  • Consolidated content are removal of information sources held in other sections
• Medical Policies and Clinical Utilization Management (UM) Guidelines
  • Added Other Criteria section
• Medical Records Submission
  • Updated content for solicited and unsolicited records
• Standards of Participation
  • Updated providers
• Quality Improvement Programs
  • Updated Behavioral Health Case Management and Patient Safety sections
• Reimbursement Requirements and Policies
  • Removal of policies available online: Observation Services, Place of Service Evaluation and Management, Preventable Adverse Events, Time Calculation for Anesthesia
  • Update to Respiratory Services not Eligible for Reimbursement, Supplies and Equipment and Tests or Procedures Prior to Admission(s) or Outpatient Services
  • Interim Bill Claims added
• Utilization Management
  • Failure to comply penalty change. See separate notification in the April Newsletter at this link: Important update to provider UM reimbursement penalties and corresponding entry in Provider Manual

 

The 2020 Wisconsin Provider Manual will be available until July 1, 2021.

 

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