Wisconsin
Provider Communications

December 2018 Anthem Wisconsin Provider Newsletter

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Title Category

Anthem Accepts Electronic Prior Authorization Requests for Prescription Medications Online

Pharmacy

Introducing the New Clinical Criteria Page for Injectable, Infused or Implanted Drugs

Pharmacy

Pharmacy Information Available at anthem.com

Pharmacy

Anthem Streamlines Member ID Cards - Use Availity to Verify Members' Cost Shares and Benefits at Time of Service

Administrative

Availity to Serve as EDI Entry Point for Electronic Submissions

Administrative

Anthem to Enhance Claim Edits for Outpatient Facility Claims

Administrative

Anthem Works to Simplify Payment Recovery Process for National Accounts Membership

Administrative

Members Can Shop for Cost-Efficient Health Care Using SmartShopper

Administrative

HEDIS® 2018 Commercial Results Are In

Administrative

Case Management Program

Administrative

ConditionCare Program Benefits Patients and Physicians

Administrative

Integrated Care Model for Plans Purchased on the Health Insurance Marketplace Benefits Patients and Physicians

Administrative

Coordination of Care

Administrative

Important Information about Utilization Management

Administrative

Members’ Rights and Responsibilities

Administrative

Vaginal Birth after Cesarean (VBAC) Certified Shared Decision Making Aid Available on the Web

Administrative

Restructure of AIM Advanced Imaging Clinical Appropriateness Guidelines

Coverage and Clinical Guidelines

Update to AIM Clinical Appropriateness Guidelines

Coverage and Clinical Guidelines

Updates to AIM Musculoskeletal Surgery Clinical Appropriateness Guidelines

Coverage and Clinical Guidelines

Interactive Care Reviewer (ICR) New Features

Coverage and Clinical Guidelines

Bundled Services and Supplies (Professional)

Reimbursement Policies

Reimbursement for Convenience Surgical Supply Kits: Professional

Reimbursement Policies

Clinical practice and preventive health guidelines available on anthem.com

Medical Policy & Clinical Guidelines

Medical Polices and Clinical Guidelines Updates - December 2018

Medical Policy & Clinical Guidelines

View reimbursement policies online at anthem.com

Reimbursement Policies

Reimbursement Policy Updates - December 2018

Reimbursement Policies

Reimbursement Policy Update - Scope of License (Professional)

Reimbursement Policies

2019 FEP Benefit information available online

Federal Employee Plan (FEP)

Coordination of Benefits for an FEP® member

Federal Employee Plan (FEP)

Benefit change for Infliximab for Federal Employee Program (FEP)

Federal Employee Plan (FEP)

New Medicare Advantage provider service phone number beginning January 1, 2019

Medicare

2019 Medicare Advantage individual benefits and formularies

Medicare

CMS Medicare Preclusion List effective April 1, 2019

Medicare

When and how to initiate Medicare Advantage reopenings

Medicare

Individual Medicare plans move compound drugs off formulary beginning January 1, 2019

Medicare

Medicare Part B drugs may include Step Therapy beginning January 1, 2019

Medicare

University of Chicago Offers Medicare Advantage Option

Medicare

Keep up with Medicare news

Medicare

Electronic data interchange (EDI) gateway update

Medicaid

Transition of Outpatient Rehabilitation Utilization Management Program effective January 1, 2019

Medicaid

NCQA: Pharmacy Management Information

Medicaid

NCQA: Practitioners’ Rights during Credentialing Process

Medicaid

Coding Spotlight: Substance Use Disorders and Smoking

Medicaid

Medical Policies and Clinical Utilization Management Guidelines Update-Wisconsin

Medicare

UPDATE: Prior Authorization Requirements for High-Level, Definitive Drug Testing Delayed

Medicaid

Prior authorization requirements for Subcutaneous Implantable Defibrillator system

Medicaid

Prior Authorization Requirements for Sublocade

Medicaid

Reimbursement Policy Update: Claims Requiring Additional Documentation

Medicaid
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