Wisconsin
Provider Communications

August 2020 Anthem Provider News - Wisconsin

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Title Category

Notice of material changes/amendments to contract and prior authorization changes - August 2020

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
- Anthem prior authorization updates for specialty pharmacy are available-August 2020*
- Medical Policy and Clinical Guideline Updates-August 2020*
- Expansion of AIM Musculoskeletal Program effective November 1, 2020*
- Reimbursement Policy Update: Claims requiring additional documentation (Facility)*
Administrative

Anthem to update formulary lists for commercial health plan pharmacy benefit

Pharmacy

Voluntary site of care outreach for oncology checkpoint inhibitors beginning August 1, 2020

Pharmacy

Anthem prior authorization updates for specialty pharmacy are available - August 2020*

Pharmacy

Pharmacy information available on anthem.com

Pharmacy

Provider contract and fee schedule notifications coming soon

Administrative

Resources to support diverse patients and communities

Administrative

Evaluation and management services correct coding (Professional)

Administrative

Migrate your EDI transactions to Availity today

Administrative

Electronic claims submission - Clinical Laboratory Improvement Amendments (CLIA)

Administrative

Anthem electronic attachments - X12 275 5010

Administrative

Coming soon: Enhance your prior authorization and inpatient admission and discharge notification via electronic and digital self-service for 2020

Administrative

Medical record standards

Administrative

Appropriate coding helps provide a comprehensive picture of patients’ health

Administrative

Medical policy and clinical guideline updates - August 2020*

Medical Policy & Clinical Guidelines

Expansion of AIM Musculoskeletal Program effective November 1, 2020*

Medical Policy & Clinical Guidelines

Reimbursement Policy Update: Claims requiring additional documentation (Facility)*

Reimbursement Policies

Medicaid News - August 2020

View this Medicaid article:
- Updates to AIM musculoskeletal program clinical appropriateness guidelines
Medicaid

Transition to AIM Rehabilitative Services clinical appropriateness guidelines

Medicaid

Medical drug benefit clinical criteria updates

Medicaid

New MCG Care Guidelines 24th edition

Medicaid

Provider data update

Medicaid

Controlling high blood pressure (CBP)

Medicaid

Medicare News - August 2020

View these Medicare articles:
- Submit behavioral health authorizations via our online Interactive Care Reviewer (ICR) tool
- Updates to AIM musculoskeletal program clinical appropriateness guidelines
- Provider data update
- Waived copays, deductibles and coinsurance for CCM, complex CCM and TCM
- AIM Musculoskeletal program expansion
- New MCG Care Guidelines 24th edition
Medicare

Medical drug benefit clinical criteria updates

Medicare

2020 Medicare risk adjustment provider trainings

Medicare
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