Wisconsin
Provider Communications

Articles Category: Policy Updates

Title Publication Category Date

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*

*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

Maximizing efficient, high quality COVID-19 screenings*

*Material Adverse Change (MAC)
COVID-19 Information - 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

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

Medical Policy and Clinical Guideline Updates - February 2020*

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

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines*

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

Updates to AIM Musculoskeletal Program Clinical Appropriateness Guidelines*

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

Important Update: Milliman Care Guideline (MCG), 23rd Edition, ORG: W0163 Pelvic Organ Prolapse Repair*

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

Outpatient Facility Edit Implementation*

January 2020 Anthem Provider News - Wisconsin Reimbursement Policies Jan 1, 2020

New Reimbursement Policies: Durable Medical Equipment, Rent to Purchase Durable Medical Equipment, and Modifiers (Professional)

December 2019 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2019

System updates for 2020 (Professional)

December 2019 Anthem Provider News - Wisconsin Reimbursement Policies Dec 1, 2019

Medical Policy and Clinical Guidelines Updates -- November 2019*

November 2019 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2019

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

November 2019 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Radiation Therapy Clinical Appropriateness Guideline*

November 2019 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Spine Surgery Clinical Appropriateness Guideline*

November 2019 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2019

Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline*

November 2019 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Nov 1, 2019

Reimbursement Policy update: Place of Service-Professional*

October 2019 Anthem Provider News - Wisconsin Reimbursement Policies Oct 1, 2019

Clinical Guideline Updates -- September 2019*

September 2019 Anthem Provider News - Wisconsin Medical Policy & Clinical Guidelines Sep 1, 2019

New Reimbursement Policies: Maternity Services and Multiple Delivery - Professional*

September 2019 Anthem Provider News - Wisconsin Reimbursement Policies Sep 1, 2019
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