Wisconsin
Provider Communications

September 2019 Anthem Provider News - Wisconsin

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Title Category

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- September 2019

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

Reminder: Changes to timely filing requirements coming in October

Administrative

Provider Transparency Update

Administrative

Anthem launches Sydney on September 1; new app offers better digital health care support to members

Administrative

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Risk Adjustment Data Validation (RADV) Audit happening now

Administrative

Claims requiring additional documentation facility reimbursement policy update

Administrative

PCP after-hours access requirements

Administrative

Clinical criteria and prior authorization updates for specialty pharmacy are available*

Pharmacy

Access requirements for behavioral health care services

Behavioral Health

Clinical Guideline Updates -- September 2019*

Medical Policy & Clinical Guidelines

New Reimbursement Policies: Maternity Services and Multiple Delivery - Professional*

Reimbursement Policies

New Reimbursement Policy: Intensity Modulated Radiation Therapy Planning and Delivery - Professional*

Reimbursement Policies

Claim editing update for Excludes1 notes

Reimbursement Policies

Medicare News -- September 2019

Medicare

Coming soon: Electronic attachments

Medicare

Clinical Criteria updates

Medicare

Customizations to the 23rd edition of the MCG Care Guidelines

Medicare

Changes to prior authorization (PA) requirements

Medicare

Pharmacy benefit manager change to IngenioRx

Medicare

Coming soon: electronic attachments

Medicaid

Prior authorization changes

Medicaid

Update: E&M with Modifier 25 same day as procedure when a prior E&M for the same or similar service has occurred (Professional)

Medicaid

Customizations to the 23rd edition of the MCG Care Guidelines

Medicaid

Medical drug Clinical Criteria updates

Medicaid
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