Updated Provider Manual now available

Anthem Blue Cross and Blue Shield (Anthem) reviews and updates our online Provider Manual annually.  The updated manual is now available on our public provider website at anthem.com. Select Providers, and choose Wisconsin from the list.  From the horizontal menu, choose Policies, Guidelines & Manuals.  Scroll down to the Provider Manual section and select Download the Manual; choose Looking for our Upcoming Provider Manual effective July 1, 2020 to view the manual. 

 

Below are the changes to the following sections in the 2020 Provider Manual listed in alphabetical order:

 

Updated content

 

• Navigation directions from anthem.com public provider website to various content throughout the manual.
• AIM Specialty Health_® (AIM)
  • Removal of Specialty Drug section and updated microsite information
• Anthem Provider Web Site
  • Updated content areas
• Availity Portal
  • Updated information on Anthem functionality
• Audit and Review
  • Policy, definitions, procedure, documents reviewed during audit and audit appeal policy updates
• Centers of Medical Excellence
  • New program Substance Use Treatment and Recovery added
• Claim Filing Tips
  • Laboratory Claims and Recommended claim fields sections – Added CLIA number submission requirement
  • Itemized Bills removed
  • Timely Filing for Claims section added
• Claim Payment Disputes
  • Updates to claim payment reconsideration and claim payment appeals sections
• Credentialing
  • Update to Credentials Committee and Program standards eligibility standards
  • HDO Type and Anthem Approved Accrediting Agency section removal of Clinical Laboratories, Dialysis Center and Portable X-ray Services
• Federal Employees Health Benefits Program
  • Submission of Claims under the Federal Employee Health Benefit Program section updated
• Insurance Requirements
  • Removed acceptable self-insurance information
• Quality Improvement Programs
  • Patient Safety for Members section updated
• Reimbursement Guidelines and Policies
  • Blood, Blood Products and Administration section update
  • Changes During Admission – CPT and HCPCS coding changes added
  • Daily Supply or One Time Charge Fee/Item – Examples removed
  • Implants – Revised for consistency with Implants Professional Reimbursement Policy
  • Itemized Bills removed – See Facility Reimbursement Policy “Claims Requiring Additional Documentation”
  • Mother and Baby claims removed
  • New services removed
  • Psychiatric Outpatient/Residential Services removed
  • Respiratory Services Not Eligible for Separate Reimbursement added
• Risk Adjustments
  • Encounter Data for Risk Adjustment Purposes updated
• Standards of Participation
  • Added Clinical Laboratories, Dialysis Center and Portable X-ray Services
• Utilization Management
  • Urgent Care Review section updated

 

The 2019 Wisconsin Provider Manual will also be available until July 1, 2020.

 

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