Wisconsin
Provider Communications

October 2020 Anthem Provider News - Wisconsin

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Title Category

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - October 2020

Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
Administrative

New Blue HPN® network included in plans available for employee open enrollment Fall 2020

Products & Programs

Anthem updates formulary lists for commercial health plan pharmacy benefit

Pharmacy

Prior authorization updates for specialty pharmacy are available - October 2020*

Pharmacy

Updated coverage for breast cancer prevention medications

Pharmacy

FDA approvals and expedited pathways used - New Molecular Entities (NMEs)

Pharmacy

Pharmacy information available at anthem.com

Pharmacy

Update to the Provider Manual

Administrative

National Accounts 2021 Pre-certification list*

Administrative

Anthem Chat: A fast, easy way to have your questions answered

Administrative

New medical claim attachment webinars: Register today

Administrative

Electronic member ID cards available on the Availity portal

Administrative

What Matters Most: Improving the patient experience

Administrative

Anthem Commercial Risk Adjustment (CRA) Reporting Update: New guidance on telephone-only service CPT codes for risk adjustment program

Administrative

Medical policy and clinical guideline updates - October 2020*

Medical Policy & Clinical Guidelines

Prior authorization update for Commercial Individual Business*

Medical Policy & Clinical Guidelines

Transition to AIM rehabilitative service clinical appropriateness guidelines

Medical Policy & Clinical Guidelines

Reminder: Expansion of AIM Musculoskeletal Program effective November 1, 2020

Medical Policy & Clinical Guidelines

Reimbursement policy update: Emergency department - leveling of Evaluation and Management services (Facility)*

Reimbursement Policies

Reimbursement policy update: Claims requiring additional documentation policy (Facility)

Reimbursement Policies

Reimbursement policy update: Laboratory and venipuncture (Professional)*

Reimbursement Policies

Federal Employee Program® expands specialty pharmacy prior authorization list*

Federal Employee Plan (FEP)

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations

Medicaid

Prior authorization requirements for E0482

Medicaid

Patient360 enhancement for medical providers

Medicaid

Coding spotlight: Providers guide to coding for behavioral health disorders

Medicaid

Medicare News - October 2020

View these Medicare articles:
- Evaluation and management services correct coding
- Medical policies and clinical utilization management guidelines update
- Prior authorization requirements for the below codes effective January 2021
Medicare

Medical drug benefit clinical criteria updates

Medicare

Prior authorization requirements for the below codes effective January 1, 2021

Medicare

Social determinants of health support expanding with GroundGame Health

Medicare

Provider transparency update

Medicare
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