Wisconsin
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

MCG Care Guidelines 26th Edition*

*Material Adverse Change (MAC)
May 2022 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2022

AIM Specialty Health Outpatient Rehabilitative and Habilitative Services clinical appropriateness guidelines updates*

*Material Adverse Change (MAC)
March 2022 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Mar 1, 2022

Medical policy and clinical guideline updates - February 2022*

*Material Adverse Change (MAC)
February 2022 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Feb 1, 2022

Update: Continuation of skilled nursing facility (SNF) program in Wisconsin

February 2022 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Feb 1, 2022

Reimbursement policy update: Multiple diagnostic imaging facility*

*Material Adverse Change (MAC)
January 2022 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2022

Medical policy and clinical guideline updates - December 2021*

*Material Adverse Change (MAC)
December 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Specialty Health Musculoskeletal Interventional Pain Management Clinical Appropriateness Guideline*

*Material Adverse Change (MAC)
December 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Specialty Health Cardiology Clinical Appropriateness Guidelines*

*Material Adverse Change (MAC)
December 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline*

*Material Adverse Change (MAC)
December 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2021

Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guideline*

*Material Adverse Change (MAC)
December 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2021

RETRACTION: Inpatient Facility Transfers - facility reimbursement policy

December 2021 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2021

Reimbursement policy update: Assistant at Surgery (Modifiers 80, 81, 82, AS) - Professional*

*Material Adverse Change (MAC)
December 2021 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2021

New reimbursement policy update: Modifier 62: Co-Surgeon Services and Modifier 66: Surgical Teams - Professional*

*Material Adverse Change (MAC)
December 2021 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2021

Reimbursement policy update: Virtual Visits - Professional and Facility

December 2021 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2021

Clarification to reimbursement policy updates: Modifier Rules and Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation - professional

November 2021 Anthem Provider News - Wisconsin Reimbursement Policies Nov 1, 2021

Medical policy and clinical guideline updates - October 2021*

*Material Adverse Change (MAC)

October 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Oct 1, 2021

Continuation of skilled nursing facility (SNF) program in Wisconsin

October 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Oct 1, 2021

Reimbursement policy clarification: Claims requiring additional documentation - Facility

October 2021 Anthem Provider News - Wisconsin Reimbursement Policies Oct 1, 2021

Reimbursement policy update: Sexually transmitted infections testing - Professional*

*Material Adverse Change (MAC)
September 2021 Anthem Provider News - Wisconsin Reimbursement Policies Sep 1, 2021

New reimbursement policy update: Inpatient Facility Transfers - Facility* - RETRACTION

*Material Adverse Change (MAC)
September 2021 Anthem Provider News - Wisconsin Reimbursement Policies Sep 1, 2021

Reimbursement policy update: Drug Screen Testing - Professional*

*Material Adverse Change (MAC)
September 2021 Anthem Provider News - Wisconsin Reimbursement Policies Sep 1, 2021

Transition to AIM Specialty Health imaging of the heart clinical appropriateness guideline for computed tomography to detect coronary artery calcification

August 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Aug 1, 2021

Reimbursement policy update: Virtual Visits (Professional and Facility)*

*Material Adverse Change (MAC)
August 2021 Anthem Provider News - Wisconsin Reimbursement Policies Aug 1, 2021

Reimbursement policy update: Claims requiring additional documentation (Facility)*

*Material Adverse Change (MAC)
August 2021 Anthem Provider News - Wisconsin Reimbursement Policies Aug 1, 2021

Reimbursement policy update: Distinct Procedural Service, Modifiers 59 and XE, XP, XS, & XU*

*Material Adverse Change (MAC)
August 2021 Anthem Provider News - Wisconsin Reimbursement Policies Aug 1, 2021

Medical Policy and Clinical Guideline Updates - July 2021*

*Material Adverse Change (MAC)
July 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jul 1, 2021

Reimbursement policy update: Consultations - Professional*

*Material Adverse Change (MAC)
July 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jul 1, 2021

Medical policy and clinical guideline updates - June 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Prior authorization for genetic testing medical policy effective September 1, 2021*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM advanced imaging clinical appropriateness guidelines*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Updates to AIM musculoskeletal program clinical appropriateness guidelines*

*Material Adverse Change and/or Prior Authorization Change (MAC)
June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2021

Update to evaluation and management services correct coding - Professional

June 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jun 1, 2021

Reimbursement policy update: Outpatient facility claim edits

June 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jun 1, 2021

RETRACTION: AIM Rehabilitative program - initial evaluations and site of service reviews

June 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 4, 2021

New prior authorization requirement: Kidney transplantation*

*Material Adverse Change (MAC)
May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Update to AIM Specialty Health oncologic imaging clinical appropriateness guidelines

May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Updated AIM rehabilitative program effective August 1, 2021 - Initial evaluations and site of service reviews RETRACTION - Please refer to article published May 4, 2021

May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Modification to voluntary Cancer Care Quality Program (CCQP) enhanced reimbursement to begin July 1, 2021

May 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2021

Reimbursement policy update: Claims Requiring Additional Documentation - Facility*

*Material Adverse Change (MAC)
May 2021 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2021

Reimbursement policy reminder: Readmission - Facility

May 2021 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2021

Reimbursement policy update: Frequency editing - Professional

May 2021 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2021

Medical policy and clinical guideline updates - April 2021*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

Update: Clinical guideline adoption postponed*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

MCG Care Guidelines 25th Edition available*

*Material Adverse Change (MAC)
April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

Updated guidance on prior authorization requirements for admissions to in-network skilled nursing facilities (SNFs)

April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

Update for Commercial providers: AIM sleep program CPT code E1399, NOC: Durable medical equipment, miscellaneous

April 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

Maximizing efficient, high quality COVID-19 screenings*

*Material Adverse Change (MAC)
COVID-19 Information - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2021

Update: Notice of changes to the AIM Small Joint Surgery guideline

March 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Mar 1, 2021

Claims editing update for ICD-10-CM Excludes 1 notes

March 2021 Anthem Provider News - Wisconsin Reimbursement Policies Mar 1, 2021

Medical Policy and Clinical Guideline Updates - February 2021*

February 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Feb 1, 2021

Reimbursement policy update: Emergency Room Transfers - Facility*

February 2021 Anthem Provider News - Wisconsin Reimbursement Policies Feb 1, 2021

Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility*

February 2021 Anthem Provider News - Wisconsin Reimbursement Policies Feb 1, 2021

Medical Policy and Clinical Guideline Updates - January 2021*

January 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jan 1, 2021

MCG Care Guidelines 24th Edition Customization*

January 2021 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jan 1, 2021

Reimbursement policy update: Multiple diagnostic imaging procedures - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Frequency editing - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Guidelines for reporting timed units for physical medicine and rehabilitation - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Modifier Rules - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

Reimbursement policy update: Unit frequency maximum for drugs and biologicals - Professional*

January 2021 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2021

Medical policy and clinical guideline updates - December 2020*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Anthem expands hospice policy

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Cardiology clinical appropriateness guidelines*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Advanced Imaging clinical appropriateness guideline*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Updates to AIM Radiation Oncology clinical appropriateness guideline*

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Transition to AIM Rehabilitative Services clinical appropriateness guidelines

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Clinical practice and preventive health guidelines available on anthem.com

December 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Dec 1, 2020

Reimbursement policy update: Bundled services and supplies (Professional)*

December 2020 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2020

Reimbursement policy update: DRG newborn inpatient stays (Facility)*

December 2020 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2020

Medical policy and clinical guideline updates - November 2020*

November 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2020

Correction to Prior Authorization Update for Commercial business*

November 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2020

Reminder: Post-service reviews using AIM

November 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2020

New reimbursement policy: Documentation standards for episodes of care (Professional)*

November 2020 Anthem Provider News - Wisconsin Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Modifier rules (Professional)*

November 2020 Anthem Provider News - Wisconsin Reimbursement Policies Nov 1, 2020

Reimbursement policy update: Bundled services and supplies (Professional)*

November 2020 Anthem Provider News - Wisconsin Reimbursement Policies Nov 1, 2020

Medical policy and clinical guideline updates - October 2020*

October 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Oct 1, 2020

Prior authorization update for Commercial Individual Business*

October 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Oct 1, 2020

Transition to AIM rehabilitative service clinical appropriateness guidelines

October 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Oct 1, 2020

Reminder: Expansion of AIM Musculoskeletal Program effective November 1, 2020

October 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Oct 1, 2020

Reimbursement policy update: Emergency department - leveling of Evaluation and Management services (Facility)*

October 2020 Anthem Provider News - Wisconsin Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Claims requiring additional documentation policy (Facility)

October 2020 Anthem Provider News - Wisconsin Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Laboratory and venipuncture (Professional)*

October 2020 Anthem Provider News - Wisconsin Reimbursement Policies Oct 1, 2020

Reimbursement policy update: Distinct Procedural Services- Modifiers 59, XE, XP, XS, XU (Professional)*

September 2020 Anthem Provider News - Wisconsin Reimbursement Policies Sep 1, 2020

Reimbursement policy update: Frequency Editing (Professional)*

September 2020 Anthem Provider News - Wisconsin Reimbursement Policies Sep 1, 2020

Medical policy and clinical guideline updates - August 2020*

August 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Aug 1, 2020

Expansion of AIM Musculoskeletal Program effective November 1, 2020*

August 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Aug 1, 2020

Reimbursement Policy Update: Claims requiring additional documentation (Facility)*

August 2020 Anthem Provider News - Wisconsin Reimbursement Policies Aug 1, 2020

New MCG 24th Edition Guidelines

July 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jul 1, 2020

Update: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements and setting determinations*

July 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jul 1, 2020

Medical Policy and Clinical Guideline Updates - June 2020*

June 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2020

Transition to AIM Rehabilitative Services Clinical Appropriateness Guidelines*

June 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2020

REMINDER: AIM Rehabilitative Program Pediatric Exclusions

June 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Jun 1, 2020

New Reimbursement Policies: Nurse Practitioner and Physician Assistant Services (Professional)*

June 2020 Anthem Provider News - Wisconsin Reimbursement Policies Jun 1, 2020

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM MSK Interventional Pain Management Clinical Appropriateness Guideline*

May 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2020

Updates to AIM Musculoskeletal Program Joint Surgery Clinical Appropriateness Guidelines*

May 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines May 1, 2020

Reimbursement Policy Update: Claims requiring additional documentation (Facility)*

May 2020 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2020

Reminder about system updates

May 2020 Anthem Provider News - Wisconsin Reimbursement Policies May 1, 2020

MCG Care Guidelines 24th Edition*

April 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2020

UPDATE: Notice of changes to the AIM Musculoskeletal Program prior authorization requirements*

April 2020 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Apr 1, 2020
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