Wisconsin
Provider Communications

Articles Month: March 2023

Title Publication Category Date

Enhanced outpatient facility editing for National Correct Coding Initiative

April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Authorizations for post-acute care services for Commercial members*

*Material Adverse Change (MAC)
April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Genetic testing CPT code list update for Carelon Medical Benefits Management (formerly AIM Specialty Health)*

*Material adverse change (MAC)
April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

CAA: Maintain your online provider directory information

April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Update use of modifier 25 for billing for visits that include preventive and problem-oriented evaluation and management services

April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Helping to reduce delays when submitting attachments

April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Medical Oncology Program ProviderPortal case entry enhancements

April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Expansion of Carelon Medical Benefits Management, Inc. cardiology, genetic testing, and radiology programs effective August 1, 2023*

*Material adverse change (MAC)

April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Survey for all skilled nursing facilities

April 2023 Provider News - Wisconsin Digital Tools Mar 31, 2023

Update to Claim Payment Dispute process*

*Material adverse change (MAC)

April 2023 Provider News - Wisconsin Administrative Mar 31, 2023

Submitting prior authorizations is getting easier

April 2023 Provider News - Wisconsin Digital Tools Mar 31, 2023

Genetic Testing claim edits

April 2023 Provider News - Wisconsin Policy Updates Mar 31, 2023

Survey for all skilled nursing facilities

April 2023 Provider News - Wisconsin Digital Tools Mar 31, 2023

Reimbursement policy update: Documentation and Reporting Guidelines for Evaluation and Management Services - Professional

April 2023 Provider News - Wisconsin Reimbursement Policies Mar 31, 2023

Notification Regarding Reimbursement Changes to COVID-19 Vaccine Administration*

*Material adverse change (MAC)

April 2023 Provider News - Wisconsin Reimbursement Policies Mar 31, 2023

Pay Doctor Bill (provider payment option) - General FAQ

April 2023 Provider News - Wisconsin Products & Programs Mar 31, 2023

Let’s Vaccinate

April 2023 Provider News - Wisconsin Products & Programs Mar 31, 2023

Bundled Services and Supplies - Professional*

*Material adverse change (MAC)

April 2023 Provider News - Wisconsin Reimbursement Policies Mar 31, 2023

Pharmacy information available on our provider website

April 2023 Provider News - Wisconsin Pharmacy Mar 31, 2023

HEDIS 2023 Federal Employee Program medical record request requirements

April 2023 Provider News - Wisconsin Federal Employee Plan (FEP) Mar 31, 2023

FEP Quality Reimbursement Program update

April 2023 Provider News - Wisconsin Federal Employee Plan (FEP) Mar 31, 2023

Authorizations for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services for consumers with individual, group retiree solutions (GRS), and dual-eligible plans from Medicare Advantage

April 2023 Provider News - Wisconsin Medicare Mar 31, 2023

E-visits

April 2023 Provider News - Wisconsin Medicare Mar 31, 2023

Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures

April 2023 Provider News - Wisconsin Medicaid Mar 31, 2023

Correct coding for hospital outpatient clinic visits for Medicaid

April 2023 Provider News - Wisconsin Medicaid Mar 31, 2023

Ready, set, renew!

April 2023 Provider News - Wisconsin Medicaid Mar 31, 2023

Keep up with Medicaid News - April 2023

- Clinical Criteria Updates
- Notification of Pregnancy Incentive Program discontinuation
- Electronic visit verification
- Prior authorization requirement changes
April 2023 Provider News - Wisconsin Medicaid Mar 31, 2023

Keep up with Medicare News - April 2023

- Clinical Criteria Updates
- Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Imjudo, Pedmark, Tecvayli, Tzield, Vegzelma)
- Blue Cross and Blue Shield expands specialty pharmacy precertification list (Elahere)
- New specialty pharmacy medical step therapy requirements (Avastin, Byooviz, Cimerli, Eylea, Lucentis, Vabysmo)
- Genetic testing CPT code list update for Carelon Medical Benefits Management (formerly AIM Specialty Health)
- Clinical Criteria updates
April 2023 Provider News - Wisconsin Medicare Mar 31, 2023

Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures

March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update*

*Material adverse change (MAC)

March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

New policy for EMR clinical data sharing and ADT notifications*

*Material Adverse Change (MAC)
March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

Controlling High Blood Pressure and Submitting Compliant Readings

March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

March is National Colorectal Cancer Awareness Month

March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

Advancing Mental Health Equity for Youth & Young Adults

March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews

March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

Time to prepare for HEDIS medical record review

March 2023 Anthem Provider News - Wisconsin Administrative Mar 1, 2023

Reimbursement policy update: Modifiers 25 and 57 - Professional

March 2023 Anthem Provider News - Wisconsin Reimbursement Policies Mar 1, 2023

Specialty pharmacy updates for March 2023*

*Material adverse change (MAC)

March 2023 Anthem Provider News - Wisconsin Pharmacy Mar 1, 2023

Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023

March 2023 Anthem Provider News - Wisconsin Products & Programs Mar 1, 2023

Policy Update Modifiers 25 and 57

March 2023 Anthem Provider News - Wisconsin Medicaid Mar 1, 2023

Keep up with Medicaid News - March 2023

- Medical Policies and Clinical Utilization Management Guidelines update
Clinical Criteria updates
- Prior authorization updates for medications billed under the medical benefit (Carvykti)
- Prior authorization updates for medications billed under the medical benefit (Aduhelm)
- Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List
- Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines - Material adverse change (MAC)
March 2023 Anthem Provider News - Wisconsin Medicaid Mar 1, 2023

Pharmacy information available on our provider website

March 2023 Anthem Provider News - Wisconsin Pharmacy Mar 1, 2023

Annual planned visits

March 2023 Anthem Provider News - Wisconsin Medicare Mar 1, 2023

Controlling High Blood Pressure and Submitting Compliant Readings

March 2023 Anthem Provider News - Wisconsin Medicare Mar 1, 2023

Keep up with Medicare News - March 2023

- Update: Carelon Medical Benefits Management, Inc. Cardiology Clinical Appropriateness Guidelines CPT Code List
- Updates to Carelon Medical Benefits Management, Inc. Cardiac Clinical Appropriateness Guidelines - Material adverse change (MAC)
- Carelon Medical Benefits Management, Inc. Genetic Testing Clinical Appropriateness Guidelines CPT code list update
- What date to select for inpatient admissions for claims
- Clinical Criteria updates
- New specialty pharmacy medical step therapy requirements (Neulasta, Neulasta OnPro, Udenyca)
March 2023 Anthem Provider News - Wisconsin Medicare Mar 1, 2023

Shared savings and transition care management after inpatient discharges

March 2023 Anthem Provider News - Wisconsin Medicare Mar 1, 2023

Informational Update Modifier Usage

March 2023 Anthem Provider News - Wisconsin Medicare Mar 1, 2023
Page 1 of 1