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PROVIDER NEWSWISCONSIN PROVIDER NEWS WISCONSIN PROVIDER NEWS WISCONSIN Provider Home Archives Select Market Subscribe to Email Provider News Your digital resource for all news and announcements related to policy updates, digital tools, reimbursement and prior authorization changes, educational opportunities, and more. View the current newsletter Search Submit Search FILTER BY DATE After Date - Before Date * Recent Updates CATEGORIES * Administrative * Digital Solutions * Behavioral Health * Education and Training * Webinars * Policy Updates * Medical Policy & Clinical Guidelines * Prior Authorization * Reimbursement Policies * Products & Programs * Dental * Federal Employee Program (FEP) * Pharmacy * Quality Management * Optimizing HEDIS & STARS * State & Federal -------------------------------------------------------------------------------- * BadgerCare Plus and Medicaid SSI Programs * Commercial * Medicare Advantage -------------------------------------------------------------------------------- * Material Adverse Changes -------------------------------------------------------------------------------- RECENT PUBLICATIONS 1. March 2024 Provider Newsletter 2. February 2024 Provider Newsletter 3. January 2024 Provider Newsletter 4. December 2023 Provider Newsletter 5. November 2023 Provider Newsletter 6. View All Publications » -------------------------------------------------------------------------------- * Provider Home | BadgerCare Plus and Medicaid SSI ProgramsProvider Home | Commercial, Medicare Advantage * Archive | BadgerCare Plus and Medicaid SSI ProgramsArchive | Commercial, Medicare Advantage * Subscribe to Email -------------------------------------------------------------------------------- Change MarketChange Market--------CaliforniaColoradoConnecticutGeorgiaIndianaKentuckyMaineMissouriNevadaNew HampshireNew YorkOhioPennsylvaniaVirginiaWisconsin Highlights KEY UPDATES Administrative / Digital Solutions | Commercial / Medicare Advantage / BadgerCare Plus and Medicaid SSI Programs | Mar 5, 2024 CHANGE HEALTHCARE CYBERSECURITY UPDATE – MARCH 5, 2024 -------------------------------------------------------------------------------- What's New RECENT UPDATES DateCategory Quality Management / Optimizing HEDIS & STARS | Medicare Advantage | Mar 19, 2024 HEDIS ECDS Coding Booklet 2024 - Medicare Policy Updates / Medical Policy & Clinical Guidelines | BadgerCare Plus and Medicaid SSI Programs | Mar 18, 2024 Clinical Criteria updates — December 2023 Education and Training / Webinars | Commercial / Medicare Advantage / BadgerCare Plus and Medicaid SSI Programs | Mar 14, 2024 Roster Automation Template and Rules of Engagement training Quality Management / Optimizing HEDIS & STARS | Commercial / Medicare Advantage | Mar 14, 2024 Social Need Screening and Intervention (SNS-E) Administrative | Commercial | Mar 12, 2024 Important reminder: The correct original claim number must be included if submitting a corrected claim Policy Updates / Prior Authorization | Medicare Advantage | Mar 11, 2024 Prior authorization requirement changes effective July 1, 2024 Quality Management | BadgerCare Plus and Medicaid SSI Programs | Mar 8, 2024 HEDIS® 2024 documentation for Colorectal Cancer Screening (COL-E) Quality Management | Commercial / Medicare Advantage | Mar 8, 2024 HEDIS® 2024 documentation for Colorectal Cancer Screening (COL-E) Products & Programs / Pharmacy | BadgerCare Plus and Medicaid SSI Programs | Mar 6, 2024 Prior authorization updates for medications billed under the medical benefit Administrative / Digital Solutions | Commercial / Medicare Advantage / BadgerCare Plus and Medicaid SSI Programs | Mar 5, 2024 Change Healthcare cybersecurity update – March 5, 2024 Policy Updates / Medical Policy & Clinical Guidelines | Medicare Advantage | Mar 4, 2024 Medical Policies and Clinical Utilization Management Guidelines update Administrative / Digital Solutions | Commercial | Mar 1, 2024 Expansion of Carelon Medical Benefits Management, Inc. programs Policy Updates / Reimbursement Policies | Commercial | Mar 1, 2024 Material adverse change Reimbursement policy update: Ambulance Transportation – Professional Policy Updates / Reimbursement Policies | Commercial | Mar 1, 2024 Material adverse change Reimbursement policy update: Laboratory and Venipuncture Services – Professional and Facility Products & Programs / Pharmacy | Commercial | Mar 1, 2024 Important information about your Anthem patients’ Botox prescriptions Products & Programs / Pharmacy | Commercial | Mar 1, 2024 Material adverse change Designated specialty pharmacy network updates Products & Programs / Pharmacy | Commercial | Mar 1, 2024 Pharmacy information available on our provider website Quality Management | Commercial / BadgerCare Plus and Medicaid SSI Programs | Mar 1, 2024 Encourage Cervical Cancer Screening (CCS) Policy Updates / Medical Policy & Clinical Guidelines | Medicare Advantage | Mar 1, 2024 Carelon Medical Benefits Management, Inc. genetic testing code updates Education and Training | Commercial / BadgerCare Plus and Medicaid SSI Programs | Mar 1, 2024 Congenital syphilis intervention opportunities for neonatal and pediatric providers Products & Programs / Pharmacy | Medicare Advantage | Mar 1, 2024 Overview of Medicare risk adjustment in-office prospective programs Administrative | Medicare Advantage | Mar 1, 2024 CAA: Maintain your online provider directory information Quality Management | Commercial / BadgerCare Plus and Medicaid SSI Programs | Mar 1, 2024 Cervical Cancer Screening (CCS) and Prenatal and Postpartum Care (PPC) for HEDIS Education and Training | BadgerCare Plus and Medicaid SSI Programs | Mar 1, 2024 Resources to support your diverse patient panel Quality Management | Commercial | Mar 1, 2024 Boost annual preventive care visits: Tips and resources: An ounce of prevention is worth a pound of cure Administrative / Digital Solutions | Medicare Advantage | Feb 29, 2024 Expansion of Carelon Medical Benefits Management, Inc. programs effective April 1, 2024 Quality Management / Optimizing HEDIS & STARS | Commercial / Medicare Advantage | Feb 25, 2024 Breast Cancer Screening (BCS-E) Administrative / Digital Solutions | Commercial / Medicare Advantage / BadgerCare Plus and Medicaid SSI Programs | Feb 25, 2024 Change Healthcare cybersecurity update Quality Management / Optimizing HEDIS & STARS | Commercial / Medicare Advantage | Feb 23, 2024 Adult Immunization Status (AIS-E) Quality Management / Optimizing HEDIS & STARS | Commercial / Medicare Advantage | Feb 23, 2024 Depression Screening and Follow-Up for Adolescents and Adults (DSF-E) Products & Programs / Pharmacy | Commercial | Feb 22, 2024 Material adverse change Specialty pharmacy updates — March 2024 Administrative / Digital Solutions | Commercial | Feb 21, 2024 Beginning February 2024, you can submit Physical Health prior authorizations through the Authorization application on Availity.com Products & Programs / Pharmacy | BadgerCare Plus and Medicaid SSI Programs | Feb 21, 2024 Prior authorization updates for medications billed under the medical benefit Policy Updates / Medical Policy & Clinical Guidelines | BadgerCare Plus and Medicaid SSI Programs | Feb 21, 2024 Medical Policies and Clinical Utilization Management Guidelines update Quality Management | Commercial / Medicare Advantage / BadgerCare Plus and Medicaid SSI Programs | Feb 21, 2024 Resources to Control High Blood Pressure (Hypertension) Products & Programs / Pharmacy | Commercial | Feb 20, 2024 Material adverse change Prior authorization updates for therapeutic duplication of specialty drugs Policy Updates / Medical Policy & Clinical Guidelines | Medicare Advantage | Feb 20, 2024 Clinical Criteria updates — December 2023 Products & Programs / Pharmacy | Medicare Advantage | Feb 16, 2024 Anthem expands specialty pharmacy precertification list Policy Updates / Prior Authorization | BadgerCare Plus and Medicaid SSI Programs | Feb 16, 2024 Prior authorization requirement changes effective May 1, 2024 Code 64505 Policy Updates | Medicare Advantage | Feb 16, 2024 MCG Care Guidelines 27th edition update Quality Management | Medicare Advantage | Feb 7, 2024 HEDIS® 2024 documentation for Care of Older Adults (COA) Quality Management | Commercial / Medicare Advantage / BadgerCare Plus and Medicaid SSI Programs | Feb 6, 2024 HEDIS 2024 documentation for Controlling High Blood Pressure (CBP) and Statin Therapy for Patients with Cardiovascular Disease (SPC) Policy Updates / Prior Authorization | Medicare Advantage | Feb 1, 2024 Prior authorization requirement changes effective May 1, 2024 Codes G0481 - G0483 Quality Management | BadgerCare Plus and Medicaid SSI Programs | Feb 1, 2024 Improving Hispanic heart health Administrative / Digital Solutions | Commercial | Feb 1, 2024 Update: Training for digital requests for additional information (Digital RFAI) Policy Updates | Commercial | Feb 1, 2024 Material adverse change MCG care guidelines 27th edition update Policy Updates / Prior Authorization | Commercial | Feb 1, 2024 Material adverse change Claims Match Enhancement for Carelon Medical Benefits Management, Inc. Genetic Testing Quality Management | Medicare Advantage | Feb 1, 2024 Improving Hispanic heart health Quality Management | Commercial | Feb 1, 2024 Improving Hispanic heart health Products & Programs | BadgerCare Plus and Medicaid SSI Programs | Feb 1, 2024 Bringing whole person care to sickle cell disease management