CommercialNovember 1, 2019

November 2019 Anthem Provider News - Wisconsin

Administrative

AdministrativeCommercialNovember 1, 2019

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

AdministrativeCommercialNovember 1, 2019

Additional improvements coming to anthem.com

AdministrativeCommercialNovember 1, 2019

Appropriate coding helps provide a comprehensive picture of patients’ health

Policy Updates

Medical Policy & Clinical GuidelinesCommercialNovember 1, 2019

Medical Policy and Clinical Guidelines Updates -- November 2019*

Medical Policy & Clinical GuidelinesCommercialNovember 1, 2019

Updates to AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guideline*

Medical Policy & Clinical GuidelinesCommercialNovember 1, 2019

Updates to AIM Radiation Therapy Clinical Appropriateness Guideline*

Medical Policy & Clinical GuidelinesCommercialNovember 1, 2019

Updates to AIM Spine Surgery Clinical Appropriateness Guideline*

Medical Policy & Clinical GuidelinesCommercialNovember 1, 2019

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline*

Products & Programs

Products & ProgramsCommercialNovember 1, 2019

REMINDER: new AIM Rehabilitative Program effective November 1, 2019

PharmacyCommercialNovember 1, 2019

Anthem clinical criteria and prior authorization updates for specialty pharmacy are available*

PharmacyCommercialNovember 1, 2019

Remaining members will transition to new PBM, IngenioRx, on January 1, 2020

State & Federal

State & FederalMedicare AdvantageNovember 1, 2019

Medicare News -- November 2019

State & FederalMedicare AdvantageNovember 1, 2019

Blue Cross and Blue Shield Association mandate about Medicare Advantage care management and provider engagement

State & FederalMedicare AdvantageNovember 1, 2019

CMS reminder: expedited/urgent requests

State & FederalBadgerCare Plus and Medicaid SSI ProgramsNovember 1, 2019

New Reimbursement Policy: Update Drug Screen Testing

State & FederalBadgerCare Plus and Medicaid SSI ProgramsNovember 1, 2019

Electronic submission is preferred method for requesting pharmacy prior authorization