Wisconsin
Provider Communications

September 2020 Anthem Provider News - Wisconsin

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Title Category

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

Site of care medical necessity reviews expands to numerous surgical procedures beginning December 1, 2020*

Products & Programs

Meet your Cancer Care Navigator

Anthem’s new cancer support program helps improve outcomes while easing burdens for you and your patients.
Products & Programs

Predictive analytics guide proactive support to patients undergoing chemotherapy resulting in lowered admissions

Products & Programs

Anthem to update formulary lists for commercial health plan pharmacy benefit

Pharmacy

Specialty pharmacy updates are available - September 2020*

Pharmacy

New provider directory indicators for medication assisted treatment (MAT) providers

Administrative

EDI Gateway migration deadline is September 15, 2020

Administrative

Providers can now receive and respond to medical record requests for post-pay audit via Change Healthcare’s Assurance Attach Assist Module

Administrative

Enhanced medical records submission process to support claims processing

Administrative

Patient360 adds care gap alert feedback for medical providers

Administrative

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2020 Prospective Program continues

Administrative

Reimbursement policy update: Distinct Procedural Services- Modifiers 59, XE, XP, XS, XU (Professional)*

Reimbursement Policies

Reimbursement policy update: Frequency Editing (Professional)*

Reimbursement Policies

Medical drug benefit clinical criteria updates

Medicaid

Medical policies and clinical utilization management guidelines update

Medicaid

What Matters Most online training course: Improving patient experience

Medicaid

Update: Notice of changes to the AIM musculoskeletal program

Medicare

Medical drug benefit clinical criteria updates

Medicare
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