CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2024

January 2024 Provider Newsletter

Featured Articles

Digital SolutionsCommercialDecember 26, 2023

Training for digital requests for additional information (Digital RFAI)

Education & TrainingCommercialJanuary 1, 2024

Important information about your Anthem patients’ specialty prescriptions

Quality ManagementCommercialNovember 20, 2023

Annual preventive care visits

Administrative

AdministrativeMedicare AdvantageJanuary 1, 2024

Inappropriate primary diagnosis

AdministrativeBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2024

Inappropriate primary diagnosis

AdministrativeCommercialJanuary 1, 2024

Using and billing air ambulance services appropriately

AdministrativeCommercialJanuary 1, 2024

Important Changes for Active Members of Northrop Grumman Corporation

AdministrativeCommercialJanuary 1, 2024

CAA: Maintain your online provider directory information

AdministrativeMedicare AdvantageJanuary 1, 2024

Operating Engineers Local 139 offers Medicare Advantage option

Education & Training

Education & TrainingBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2024

Provider Pathways — Learn all about it

Education & TrainingBadgerCare Plus and Medicaid SSI ProgramsMarch 31, 2023

Ready, set, renew!

Policy Updates

Medical Policy & Clinical GuidelinesMedicare AdvantageDecember 1, 2023

Clinical Criteria updates — August 2023

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsDecember 4, 2023

Clinical Criteria updates — August 2023

Medical Policy & Clinical GuidelinesMedicare AdvantageJanuary 1, 2024

Genetic testing code list update

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageDecember 28, 2023

Transition to Carelon Medical Benefits Management, Inc. cardiology guidelines

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsDecember 28, 2023

Transition to Carelon Medical Benefits Management, Inc. cardiology guidelines

Medical Policy & Clinical GuidelinesCommercialJanuary 1, 2024

Carelon Medical Benefits Management, Inc. genetic testing CPT® code list update

Medical Policy & Clinical GuidelinesBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Medical Policy & Clinical GuidelinesCommercialMedicare AdvantageJanuary 1, 2024

Updates to Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines

Prior AuthorizationCommercialJanuary 1, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Prior AuthorizationMedicare AdvantageJanuary 10, 2024

Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsDecember 19, 2023

Prior authorization requirement changes effective February 1, 2024

Code 20979

Prior AuthorizationBadgerCare Plus and Medicaid SSI ProgramsDecember 8, 2023

Prior authorization requirement changes effective February 1, 2024

Code J1411

Products & Programs

DentalCommercialJanuary 1, 2024

January Dental newsletter communications

PharmacyCommercialDecember 28, 2023

Specialty pharmacy updates — January 2024

Quality Management

Quality ManagementMedicare AdvantageJanuary 1, 2024

Boost annual planned visit rates

Quality ManagementCommercialMedicare AdvantageJanuary 1, 2024

HEDIS diabetes documentation

Quality ManagementBadgerCare Plus and Medicaid SSI ProgramsJanuary 1, 2024

HEDIS diabetes documentation

WIBCBS-CDCRCM-047215-23

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).