CommercialJuly 1, 2019

July 2019 Anthem Provider News - Wisconsin

Administrative

AdministrativeCommercialJuly 1, 2019

Notice of Material Changes/Amendments to Contract and Prior Authorization Changes -- July 2019
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.

AdministrativeCommercialJuly 1, 2019

Reminder to providers: Fee schedule information

AdministrativeCommercialJuly 1, 2019

Update to Provider UM reimbursement penalties and corresponding update to Provider Manual*

AdministrativeCommercialJuly 1, 2019

Anthem Works to Simplify Payment Recovery Process for National Accounts Membership

AdministrativeCommercialJuly 1, 2019

Make the move to the Availity EDI Gateway today

AdministrativeCommercialJuly 1, 2019

Anthem Commercial Risk Adjustment (CRA) Reporting Update: 2019 Program Year Progression -- What’s in it for you and your patients?

Policy Updates

Medical Policy & Clinical GuidelinesCommercialJuly 1, 2019

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

Reimbursement PoliciesCommercialJuly 1, 2019

Clinical Validation: Professional*

Reimbursement PoliciesCommercialJuly 1, 2019

Modifier 79 reminder: Professional

Reimbursement PoliciesCommercialJuly 1, 2019

Modifier 63 reminder: Professional

Reimbursement PoliciesCommercialJuly 1, 2019

ICD-10-CM Coding Guidelines and Laterality: Professional

Products & Programs

Federal Employee Program (FEP)CommercialJuly 1, 2019

Anthem Federal Employee Health Benefit Program® (FEP) PPO Members will now require prior approval for specific Specialty Drugs and Site of Care

PharmacyCommercialJuly 1, 2019

Clinical criteria updates for specialty pharmacy

PharmacyCommercialJuly 1, 2019

Clinical Criteria coding updates for specialty pharmacy are available

State & Federal

State & FederalMedicare AdvantageJuly 1, 2019

Outpatient Rehabilitation Program transitioning to AIM

State & FederalMedicare AdvantageJuly 1, 2019

Home health billing guidelines for contracted providers

State & FederalMedicare AdvantageJuly 1, 2019

Sepsis diagnosis coding and billing reminder

State & FederalMedicare AdvantageJuly 1, 2019

Electronic claim payment reconsideration

State & FederalMedicare AdvantageJuly 1, 2019

Keep up with Medicare News -- July 2019

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2019

New service types added to Availity

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2019

Electronic claim payment reconsideration

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2019

Sepsis diagnosis coding and billing reminder

State & FederalBadgerCare Plus and Medicaid SSI ProgramsJuly 1, 2019

Coding Spotlight: Hypertension