CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024
August 2024 Provider Newsletter
Featured Articles
CommercialAugust 1, 2024
MCG Care Guidelines 28th edition
Administrative
Medicare AdvantageAugust 1, 2024
ICD-10-CM Excludes1 notesCommercialAugust 1, 2024
Device-dependent procedures — facility editing updateCommercialAugust 1, 2024
CAA: Providers required to verify their online provider directory informationBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024
Access to care standards reminderCommercialJuly 24, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsMedicare AdvantageJuly 16, 2024
Expansion of Carelon Medical Benefits Management, Inc. programsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024
Save time and get better results with optimized CPT code search in Availity EssentialsCommercialAugust 1, 2024
Coming soon: View your fee schedule in Availity Essentials Payer SpacesBehavioral Health
BadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024
Learn to Live: A Digital Mental Health Benefit for Anthem members!Education & Training
CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024
Coming soon: Provider e-Learning Resource Center for Payment IntegrityCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024
August is National Breastfeeding MonthPolicy Updates
BadgerCare Plus and Medicaid SSI ProgramsJune 27, 2024
Carelon Medical Benefits Management, Inc. updates effective October 20, 2024Medicare AdvantageJuly 5, 2024
Medical Policies and Clinical Utilization Management Guidelines updateEffective August 8, 2024
CommercialJuly 11, 2024
Material adverse change
Medical Policies and Clinical Guidelines updates — August 2024BadgerCare Plus and Medicaid SSI ProgramsJune 28, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective for dates of service on and after October 20, 2024
BadgerCare Plus and Medicaid SSI ProgramsJuly 19, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective for dates of service on and after November 17, 2024
Medicare AdvantageJuly 11, 2024
Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness GuidelinesEffective for dates of service on and after November 17, 2024
CommercialAugust 1, 2024
Material adverse change
Updates to Carelon Medical Benefits Management Clinical Appropriateness GuidelinesEffective for dates of service on and after November 17, 2024
CommercialAugust 1, 2024
Notification of authorization fax number changesBadgerCare Plus and Medicaid SSI ProgramsJune 27, 2024
Prior authorization requirement changesEffective August 1, 2024
Code L7510
BadgerCare Plus and Medicaid SSI ProgramsJune 26, 2024
Prior authorization requirement changesEffective August 1, 2024
Code C9790
BadgerCare Plus and Medicaid SSI ProgramsJune 27, 2024
Prior authorization requirement changesEffective August 1, 2024
Code L5615
CommercialAugust 1, 2024
Material adverse change
New reimbursement policy: Intraoperative Neuromonitoring — ProfessionalCommercialAugust 1, 2024
Reimbursement policy update: Modifiers 26 and TC — ProfessionalMedicare AdvantageAugust 1, 2024
Reimbursement policy update: Modifier 78CommercialAugust 1, 2024
Material adverse change
Reimbursement policy update: Professional Anesthesia ServiceCommercialAugust 1, 2024
Material adverse change
Reimbursement policy update: Bundled Services and Supplies — FacilityCommercialAugust 1, 2024
Material adverse change
Reimbursement policy update: Outpatient Facility Revenue Code Billing Requirements — FacilityMedicare AdvantageAugust 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant ServicesBadgerCare Plus and Medicaid SSI ProgramsAugust 1, 2024
Reimbursement policy update: Nurse Practitioner and Physician Assistant ServicesProducts & Programs
CommercialJuly 25, 2024
Material adverse change
Specialty pharmacy updates — February 2024Note: This article corrects the Clinical Criteria for Spravato (esketamine), which was incorrectly listed in a February 2024 article.
CommercialAugust 1, 2024
Material adverse change
Specialty pharmacy updates — August 2024Tevimbra, Tyenne, and Wezlana
WIBCBS-CDCRCM-063109-24
To view this publication online:
Visit https://providernews.anthem.com/wisconsin/publications/august-2024-provider-newsletter-3246
Or scan this QR code with your phone