Updated Provider Manual now available

Anthem Blue Cross and Blue Shield (Anthem) reviews and updates our online Provider Manuals annually.  The updated manual is now available on our public provider website at www.anthem.com.  Select Providers, Find Resources for Your State and choose Wisconsin from the list. On the Provider home page, choose Communications, Publications to view the manual.

 

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.