Wisconsin
Provider Communications

March 2023 Anthem Provider News - Wisconsin

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Title Category

Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews

Administrative

Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures

Administrative

Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update*

*Material adverse change (MAC)

Administrative

New policy for EMR clinical data sharing and ADT notifications*

*Material Adverse Change (MAC)
Administrative

Controlling High Blood Pressure and Submitting Compliant Readings

Administrative

March is National Colorectal Cancer Awareness Month

Administrative

Advancing Mental Health Equity for Youth & Young Adults

Administrative

Time to prepare for HEDIS medical record review

Administrative

Reimbursement policy update: Modifiers 25 and 57 - Professional

Reimbursement Policies

Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023

Products & Programs

Specialty pharmacy updates for March 2023*

*Material adverse change (MAC)

Pharmacy

Pharmacy information available on our provider website

Pharmacy

Policy Update Modifiers 25 and 57

Medicaid

Keep up with Medicaid News - March 2023

- Medical Policies and Clinical Utilization Management Guidelines update
Clinical Criteria updates
- Prior authorization updates for medications billed under the medical benefit (Carvykti)
- Prior authorization updates for medications billed under the medical benefit (Aduhelm)
- Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines - Material adverse change (MAC)
Medicaid

Controlling High Blood Pressure and Submitting Compliant Readings

Medicare

Informational Update Modifier Usage

Medicare

Shared savings and transition care management after inpatient discharges

Medicare

Annual planned visits

Medicare

Keep up with Medicare News - March 2023

- Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List
- Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines - Material adverse change (MAC)
- Carelon Medical Benefits Management, Inc. Genetic Testing Clinical Appropriateness Guidelines CPT code list update
- What date to select for inpatient admissions for claims
- Clinical Criteria updates
- New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)
Medicare
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