Wisconsin
Provider Communications

July 2021 Anthem Provider News - Wisconsin

Title	Category
Register now to learn strategies to help you and your practice improve clinical quality	Administrative
Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims	Administrative
Proper coding for in-home monitoring can make a measurable difference for INR	Administrative
Another mark of the pandemic: An increase in childhood obesity	Administrative
How to enroll in electronic fund transfer (EFT) for faster remittance	Digital Tools
Electronic claim response files	Digital Tools
Interactive Care Reviewer (ICR): New search option for cases submitted through ICR	Digital Tools
Update: Site of care medical necessity reviews for long-acting colony-stimulating factors not implemented on June 1, 2021* *Material Adverse Change (MAC)	Pharmacy
Designated specialty pharmacy network updates effective October 1, 2021* *Material Adverse Change (MAC)	Pharmacy
Updates for specialty pharmacy are available - July 2021* *Material Adverse Change (MAC)	Pharmacy
Certain specialty medication prior authorization requests may require additional documentation* *Material Adverse Change (MAC)	Pharmacy
Medical Policy and Clinical Guideline Updates - July 2021* *Material Adverse Change (MAC)	Medical Policy & Clinical Guidelines
Reimbursement policy update: Consultations - Professional* *Material Adverse Change (MAC)	Reimbursement Policies
Medicaid News - July 2021 View these Medicaid articles: - Specialty pharmacy prior authorization retraction notice - Infusion step therapy retraction notice - Specialty Rx precertification additional documentation notice effective August 1, 2021 - Prior authorization requirement changes effective September 1, 2021–UM AROW 1327 - February 2021 medical policies and utilization management guidelines update	Medicaid
Let’s Vaccinate	Medicaid
Attention facilities: Sending admission, discharge and transfer data to Anthem results in improved care management for patients	Medicaid
What Matters Most: Improving the patient experience	Medicaid
Resources to support your diverse patient panel	Medicaid
Coding spotlight: Mental disorders in childhood	Medicaid
March 2021 medical drug benefit clinical criteria updates	Medicaid
Prior authorization requirement changes effective September 1, 2021 - UM AROW 1837	Medicaid
Updates to AIM Specialty Health Musculoskeletal Program clinical appropriateness guidelines	Medicaid
New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing	Medicaid
Medicare News - July 2021 View these Medicare articles: - Prior authorization requirement changes effective September 1, 2021 – UM Authorization Rule Operations Workgroup (AROW) Item 1845 - Provider notification for UM Authorization Rule Operations Workgroup (AROW) Item 1846	Medicare
Let’s Vaccinate	Medicare
Attention facilities: Sending admission, discharge and transfer data to Anthem results in improved care management for patients	Medicare
Medical drug benefit clinical criteria updates	Medicare
Prior authorization requirement changes for codes A0426 and A0428 effective October 1, 2021	Medicare
New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing	Medicare
Prior authorization requirement changes effective September 1, 2021	Medicaid

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.

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Wisconsin
Provider Communications

July 2021 Anthem Provider News - Wisconsin

Register now to learn strategies to help you and your practice improve clinical quality

Timely receipt of primary payer’s EOB can help reduce timely filing denials for secondary claims

Proper coding for in-home monitoring can make a measurable difference for INR

Another mark of the pandemic: An increase in childhood obesity

How to enroll in electronic fund transfer (EFT) for faster remittance

Electronic claim response files

Interactive Care Reviewer (ICR): New search option for cases submitted through ICR

Update: Site of care medical necessity reviews for long-acting colony-stimulating factors not implemented on June 1, 2021*

Designated specialty pharmacy network updates effective October 1, 2021*

Updates for specialty pharmacy are available - July 2021*

Certain specialty medication prior authorization requests may require additional documentation*

Medical Policy and Clinical Guideline Updates - July 2021*

Reimbursement policy update: Consultations - Professional*

Medicaid News - July 2021

Let’s Vaccinate

Attention facilities: Sending admission, discharge and transfer data to Anthem results in improved care management for patients

What Matters Most: Improving the patient experience

Resources to support your diverse patient panel

Coding spotlight: Mental disorders in childhood

March 2021 medical drug benefit clinical criteria updates

Prior authorization requirement changes effective September 1, 2021 - UM AROW 1837

Updates to AIM Specialty Health Musculoskeletal Program clinical appropriateness guidelines

New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing

Medicare News - July 2021

Let’s Vaccinate

Attention facilities: Sending admission, discharge and transfer data to Anthem results in improved care management for patients

Medical drug benefit clinical criteria updates

Prior authorization requirement changes for codes A0426 and A0428 effective October 1, 2021

New reimbursement policy: Modifier 90: Reference (outside) laboratory and pass-through billing

Prior authorization requirement changes effective September 1, 2021

WisconsinProvider Communications

July 2021 Anthem Provider News - Wisconsin

Wisconsin
Provider Communications