CommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsOctober 1, 2024

October 2024 Provider Newsletter

Featured Articles

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsSeptember 12, 2024

Roster Automation updates effective November 15, 2024: enhanced reporting to increase data accuracy

Digital SolutionsMedicare AdvantageOctober 1, 2024

Introducing the Care Provider Recognition Program from Anthem

Prior AuthorizationMedicare AdvantageSeptember 6, 2024

Changes to special supplemental benefits for the chronically ill eligibility requirements


Administrative

AdministrativeCommercialOctober 1, 2024

National Accounts 2025 precertification list

AdministrativeCommercialOctober 1, 2024

Updated provider manual — November 1, 2024

Digital SolutionsMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsSeptember 18, 2024

Expansion of digital-only authorization case status notifications

Digital SolutionsCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsSeptember 4, 2024

Digital Provider Enrollment now available for additional provider types in Availity Essentials

Education & Training

Education & TrainingMedicare AdvantageSeptember 16, 2024

Seamless advance care: MyDirectives digital tool for D-SNP members

Policy Updates

Policy UpdatesMedicare AdvantageSeptember 3, 2024

Clinical Criteria updates

Effective October 4, 2024

Policy UpdatesBadgerCare Plus and Medicaid SSI ProgramsSeptember 3, 2024

Clinical Criteria updates

Effective October 6, 2024

Medical Policy & Clinical GuidelinesMedicare AdvantageSeptember 10, 2024

Medical Policies and Clinical Utilization Management Guidelines update

Effective October 10, 2024

Prior AuthorizationMedicare AdvantageSeptember 23, 2024

Prior authorization requirement changes

Effective January 1, 2025

Reimbursement PoliciesCommercialOctober 1, 2024

Material adverse change

Reimbursement policy update: Modifiers 59 and XE, XP, XS, and XU: Distinct Procedural Service — Professional

Reimbursement PoliciesBadgerCare Plus and Medicaid SSI ProgramsOctober 1, 2024

Clarification to reimbursement policy update: Nurse Practitioner and Physician Assistant Services

Products & Programs

PharmacyCommercialSeptember 16, 2024

Material adverse change

Specialty pharmacy updates — October 2024

PharmacyBadgerCare Plus and Medicaid SSI ProgramsSeptember 10, 2024

Prior authorization updates for medications billed under the medical benefit

Effective November 1, 2024
Amtagvi, iDoseTR, and Nexobrid

PharmacyBadgerCare Plus and Medicaid SSI ProgramsSeptember 9, 2024

Prior authorization updates for medications billed under the medical benefit

Effective November 1, 2024
Alyglo, Simlandi, and Winrevair

PharmacyCommercialOctober 1, 2024

Pharmacy information available on our provider website

Quality Management

Quality ManagementCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsOctober 1, 2024

Prevent flu and COVID-19: drive the change through vaccination

Quality ManagementCommercialMedicare AdvantageBadgerCare Plus and Medicaid SSI ProgramsOctober 1, 2024

HEDIS medical record submission made easier with our Remote EMR Access service

WIBCBS-CDCRCM-067888-24

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