Wisconsin
Provider Communications

January 2023 Anthem Provider News - Wisconsin

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Title Category

Professional system updates for 2023

Administrative

Outpatient system updates for 2023

Administrative

Notification regarding reimbursement changes to COVID-19 laboratory services codes*

*Material adverse change (MAC)
Administrative

Engagement with your patient counts

Administrative

Childhood Immunization Status and Lead Screening in Children for HEDIS

Administrative

Remittance advice message enhancements: Providing clear descriptions and actionable next steps

Administrative

Submitting prior authorizations digitally through Interactive Care Reviewer

Digital Tools

AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update*

*Material adverse change (MAC)
Medical Policy & Clinical Guidelines

Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List

Medical Policy & Clinical Guidelines

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines*

*Material adverse change (MAC)
Medical Policy & Clinical Guidelines

Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines *

*Material adverse change (MAC)
Medical Policy & Clinical Guidelines

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines*

*Material adverse change (MAC)
Medical Policy & Clinical Guidelines

Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines*

*Material adverse change (MAC)
Medical Policy & Clinical Guidelines

Outpatient facility revenue code billing requirements

Reimbursement Policies

Specialty pharmacy updates*

*Material adverse change (MAC)
Pharmacy

Attention physicians and lab providers: COVID-19 update regarding reimbursement

Medicaid

Childhood Immunization Status and Lead Screening in Children for HEDIS

Medicaid

Monkeypox and smallpox vaccines: Product code on claims

Medicaid

Keep up with Medicaid News - January 2023

- This is Quitting: Helping teens and young adults quit vaping
- Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
Medicaid

Cleveland-Cliffs offers Medicare Advantage option

Medicare

Keep up with Medicare news - January 2023

- Prior authorization requirement changes
- New specialty pharmacy medical step therapy requirements (Inflectra & Renflexis)
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Cimerli)
- Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
Medicare

Federal Employee Program observation conversion for musculoskeletal cases*

*Material adverse change (MAC)
Federal Employee Plan (FEP)
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