BCBSWI – Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements

November 2019 ~

On November 1, Blue Cross Blue Shield of Wisconsin (BCBSWI) has posted a notice of Material Changes/Amendments to Contract and Prior Authorization Changes, scheduled to take effect November 2019.

Material changes/amendments to contract and changes to prior authorization requirements apply to new or updated reimbursement policies, medical policies, or prior authorization requirements are listed below.

Pharmacy

• Anthem clinical criteria and prior authorization updates for specialty pharmacy are available

Medical Policies/Clinical Guidelines

• Medical Policy and Clinical Guidelines Updates – November 2019
• Updates to AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guideline
• Updates to AIM Radiation Therapy Clinical Appropriateness Guideline
• Updates to AIM Spine Surgery Clinical Appropriateness Guideline
• Updates to AIM Sleep Disorder Management Clinical Appropriateness Guideline

Other Important Updates

• Medicare and Medicaid News

For complete details on these updates, visit the BCBSWI Provider Communications page.

Source(s): November 2019 Anthem Provider News – Wisconsin;