Wisconsin
Provider Communications

June 2021 Anthem Provider News - Wisconsin

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Title Category

Answering your claims questions is easier through chat; secure messaging will sunset soon, start using chat now

Administrative

Aspire Health for members in need of palliative care

Medicaid

Complex case management program

Medicaid

Designated specialty pharmacy network updates

Pharmacy

DEXA bone scan criteria for the Federal Employee Program®

Federal Employee Plan (FEP)

Digital solution options with Availity

Digital Tools

Important information about utilization management

Medicaid

Interactive Care Reviewer’s new copy feature decreases time to submit authorization request

Digital Tools

Keep your contact information current

Administrative

Keeping up with routine vaccination during COVID-19

Medicaid

Let’s vaccinate

Products & Programs

MCG Care Guidelines 25th Edition

Medicaid

Medicaid News - June 2021

View these Medicaid articles:
- Medical drug benefit Clinical Criteria updates
- Updates to the AIM Advanced Imaging clinical appropriateness guidelines
Medicaid

Medical policies and clinical utilization management guidelines update

Medicare

Medical policy and clinical guideline updates - June 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
Medical Policy & Clinical Guidelines

Medicare News - June 2021

View these Medicare articles:
- Anthem working with Optum to collect medical records for risk adjustment
- Medical drug benefit clinical criteria updates
- Updates to the AIM advanced imaging clinical appropriateness guidelines
Medicare

Members’ Rights and Responsibilities Statement

Medicaid

Pharmacy information available at anthem.com

Pharmacy

Physicians and clinical care teams: Imaging for lower back pain does not improve outcomes, study finds

Administrative

Prior authorization for genetic testing medical policy effective September 1, 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
Medical Policy & Clinical Guidelines

Provider education program survey: Your Voice Counts

Medicaid

Regular check-ins with your clearinghouse could affect timely filing

Administrative

Reimbursement policy reminder: Inpatient readmissions

Medicare

Reimbursement policy update: Outpatient facility claim edits

Reimbursement Policies

Reminders for Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ

Medicare

RETRACTION: AIM Rehabilitative program - initial evaluations and site of service reviews

Medical Policy & Clinical Guidelines

Submit EDI corrected claims via Availity or EDI

Digital Tools

Two great learning resources on one secure portal

Digital Tools

Update to evaluation and management services correct coding - Professional

Reimbursement Policies

Updates for specialty pharmacy are available - June 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
Pharmacy

Updates to AIM advanced imaging clinical appropriateness guidelines*

*Material Adverse Change and/or Prior Authorization Change (MAC)
Medical Policy & Clinical Guidelines

Updates to AIM musculoskeletal program clinical appropriateness guidelines*

*Material Adverse Change and/or Prior Authorization Change (MAC)
Medical Policy & Clinical Guidelines
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