CommercialJanuary 1, 2021

January 2021 Anthem Provider News - Wisconsin

Administrative

AdministrativeCommercialJanuary 1, 2021

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes - January 2021
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.

AdministrativeCommercialJanuary 1, 2021

Self-service, digital transactions are fast and easy

AdministrativeCommercialJanuary 1, 2021

Procedure searches in Find Care: New sort option

AdministrativeCommercialJanuary 1, 2021

New features added to Interactive Care Reviewer

AdministrativeCommercialJanuary 1, 2021

Professional system updates for 2021

AdministrativeCommercialJanuary 1, 2021

Outpatient system updates for 2021 - Facility

AdministrativeCommercialJanuary 1, 2021

Evaluation and management changes 2021

AdministrativeCommercialJanuary 1, 2021

It is almost CAHPS survey time!

Policy Updates

Medical Policy & Clinical GuidelinesCommercialJanuary 1, 2021

MCG Care Guidelines 24th Edition Customization*

Medical Policy & Clinical GuidelinesCommercialJanuary 1, 2021

Medical Policy and Clinical Guideline Updates - January 2021*

Products & Programs

Federal Employee Program (FEP)CommercialJanuary 1, 2021

2021 FEP® benefit information available online

State & Federal

State & FederalMedicare AdvantageJanuary 1, 2021

Medical drug benefit clinical criteria updates

State & FederalMedicare AdvantageJanuary 1, 2021

Updates to AIM Specialty Health Cardiac clinical appropriateness guidelines

State & FederalMedicare AdvantageJanuary 1, 2021

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

State & FederalMedicare AdvantageJanuary 1, 2021

2020 Medicare risk adjustment provider trainings

State & FederalMedicare AdvantageJanuary 1, 2021

Keep up with Medicare news - January 2021
View these Medicare articles:
- Medicare Advantage Group Retiree Quick Reference Guide and FAQ
- Medicare Advantage Group Retiree Member Eligibility, Alpha Prefix FAQ
- SNF admission reporting requirements for D-SNP plans
- Policy Update: Nurse Practitioner and Physician Assistant Services – Professional
- Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2021

Coding spotlight: HEDIS MY 2021

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2021

Disease Management/Population Health program

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2021

Medical drug benefit clinical criteria updates

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2021

FDA approvals and expedited pathways used - new molecular entities (NMEs)

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2021

Updates to AIM clinical appropriateness guidelines for Advanced Imaging

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2021

Medicaid News - January 2021
View these Medicaid articles:
- August 2020 Medical Policies and Utilization Management Guidelines update
- Independent laboratory provider – Place of service 81
- New specialty pharmacy medical step therapy requirements
- Prior authorization requirements for Moderate to Deep Anesthesia for Dental Surgery in the Facility Setting
- Policy Update: Nurse Practitioner and Physician Assistant Services
- Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines