CommercialDecember 1, 2021

December 2021 Anthem Provider News - Wisconsin

Administrative

AdministrativeCommercialDecember 1, 2021

Prepare for the Consolidated Appropriations Act: Keep your provider directory information up to date

AdministrativeCommercialDecember 1, 2021

Plans accessing BlueHPN network go live January 1, 2022

AdministrativeCommercialDecember 1, 2021

Professional system updates for 2022

AdministrativeCommercialDecember 1, 2021

Outpatient system updates for 2022

AdministrativeCommercialDecember 1, 2021

Chlamydia is asymptomatic. Only through screening will we know for sure

AdministrativeCommercialDecember 1, 2021

Behavioral healthcare appointment access requirements

AdministrativeCommercialDecember 1, 2021

Importance of PCP after-hours messaging

AdministrativeCommercialDecember 1, 2021

Important information about utilization management

AdministrativeCommercialDecember 1, 2021

Case management program

AdministrativeCommercialDecember 1, 2021

Member rights and responsibilities

AdministrativeCommercialDecember 1, 2021

Coordination of care

AdministrativeCommercialDecember 1, 2021

Clinical practice and preventive health guidelines available on anthem.com

Digital SolutionsCommercialDecember 1, 2021

Reminder: EnrollSafe is available – electronic funds transfer enrollment portal for Anthem providers
EnrollSafe replaced CAQH Enrollhub effective November 1, 2021

Policy Updates

Medical Policy & Clinical GuidelinesCommercialDecember 1, 2021

Medical policy and clinical guideline updates - December 2021*
*Material Adverse Change (MAC)

Medical Policy & Clinical GuidelinesCommercialDecember 1, 2021

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline*
*Material Adverse Change (MAC)

Medical Policy & Clinical GuidelinesCommercialDecember 1, 2021

Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines*
*Material Adverse Change (MAC)

Medical Policy & Clinical GuidelinesCommercialDecember 1, 2021

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline*
*Material Adverse Change (MAC)

Medical Policy & Clinical GuidelinesCommercialDecember 1, 2021

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guideline*
*Material Adverse Change (MAC)

Reimbursement PoliciesCommercialDecember 1, 2021

RETRACTION: Inpatient Facility Transfers - facility reimbursement policy

Reimbursement PoliciesCommercialDecember 1, 2021

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - Professional*
*Material Adverse Change (MAC)

Reimbursement PoliciesCommercialDecember 1, 2021

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - Professional*
*Material Adverse Change (MAC)

Reimbursement PoliciesCommercialDecember 1, 2021

Reimbursement policy update: Virtual Visits - Professional and Facility

Products & Programs

PharmacyCommercialDecember 1, 2021

Specialty pharmacy updates - December 2021*
*Material Adverse Change (MAC)

PharmacyCommercialDecember 1, 2021

Pharmacy information available at anthem.com

State & Federal

State & FederalBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2021

Keep up with Medicaid News - December 2021
  • Durable medical equipment prior authorization requirement changes effective December 1, 2021
  • Updates to AIM Specialty Health musculoskeletal interventional pain management clinical appropriateness guideline
  • Medical drug benefit Clinical Criteria updates
  • Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines

State & FederalBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2021

Medical policies and clinical utilization management guidelines update

State & FederalBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2021

Prior authorization requirement changes effective December 1, 2021

State & FederalBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2021

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

State & FederalBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2021

Reimbursement policy update: Drug screen testing

State & FederalBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2021

Good news: Non-payment remittance advice enhancements are here

State & FederalBadgerCare Plus and Medicaid SSI ProgramsDecember 1, 2021

HEDIS measures: Follow-Up After ED Visits for Mental Illness and Alcohol and Other Drug Abuse or Dependence

State & FederalMedicare AdvantageDecember 1, 2021

Keep up with Medicare News - December 2021
  • Updates to AIM Specialty Health musculoskeletal interventional pain management clinical appropriateness guideline
  • Medical drug benefit clinical criteria updates
  • Protocol for providers serving members with hearing aid coverage administered by Hearing Care Solutions
  • New York City Medicare Advantage announcement
  • Medical policies and clinical utilization management guidelines update
  • Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines (WI only)

State & FederalMedicare AdvantageDecember 1, 2021

2022 Medicare Advantage service area and benefit updates

State & FederalMedicare AdvantageDecember 1, 2021

Adjudicating claims for COVID-19 vaccines, their administration and COVID-19 monoclonal antibodies

State & FederalMedicare AdvantageDecember 1, 2021

Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines

State & FederalMedicare AdvantageDecember 1, 2021

Reimbursement policy update: Drug screen testing

State & FederalMedicare AdvantageDecember 1, 2021

Good news: Non-payment remittance advice enhancements are here

State & FederalMedicare AdvantageDecember 1, 2021

Somatus is your resource for kidney care management