Missouri and Wisconsin benefit summary language updates effective Sept. 1

August 2025

We’re updating the benefit summaries for Healthy Blue Missouri and Wisconsin to clarify what qualifies as medically necessary services and materials. These updates do not change your coverage.

What’s changing

• You’ll no longer need to request confirmation numbers for certain services
• These services will now be reviewed during the claims process
• To receive payment, you must include a valid medical diagnosis for claims

Why it matters

• Reduces administrative work 
• Speeds up access to care for patients
• Helps ensure consistent review of services

Starting Sept. 1, 2025, updated diagnostic code standards will be included in all medical procedure policies and available in the Provider Reference Guide.

You can still appeal denied claims or request a clinical review. Our Peer Review Committee will evaluate these based on medical necessity guidelines.

The following procedures in Missouri and Wisconsin will change effective Sept. 1, 2025: