In a continuation of our CRA reporting update articles throughout 2019, Anthe Blue Cross (Anthem) requests your assistance with respect to our Commercial Risk Adjustment (CRA) reporting processes.

As a reminder, there are two approaches that we take (Retrospective and Prospective) to improve risk adjustment reporting accuracy.  We are focusing on performing appropriate interventions and chart reviews for patients with undocumented Hierarchical Condition Categories (HCC), to close the documentation and coding gaps that we are seeing with our members enrolled in our Affordable Care Act (ACA) compliant plans.

This month we’d like to focus on the Prospective approach, and the request to our Providers:

Anthem network providers -- usually primary care physicians -- may receive letters from our vendor, Inovalon, requesting that physicians:

  1. schedule a comprehensive visit with patients identified to confirm or deny if previously coded or suspected diagnoses exists, and
  2. submit a Health Assessment documenting the previously coded or suspected diagnoses (also called a SOAP Note -- Subjective, Objective, Assessment and Plan).


Incentives for properly submitted Health Assessments (in addition to the office visit reimbursement):

  • $100 submitted electronically
  • $50 submitted via fax

 

Health Assessment requests through Inovalon

 

We have engaged Inovalon -- an independent company that provides secure, clinical documentation services -- to help us comply with provisions of the ACA that require us to assess members’ relative health risk level.  In the coming weeks and months, Inovalon will be sending letters to providers as part of our risk adjustment cycle, asking for their help with completing health assessments for some of our members.

 

This year will bring a new round of assessments. As a reminder, chronic conditions must be coded every year, and we encourage you to code to the greatest level of specificity on all Anthem claim submissions.  If you have questions about the requests you receive, you can reach Inovalon directly at 1-866-682-6680.

 

Maximize your Incentive opportunity: submit electronically via Inovalon’s ePASS® tool

 

Join an ePASS webinar to learn how to submit a Health Assessment electronically and maximize your incentive opportunities.  They are offered every Wednesday from 3:00 - 4:00pm EST.  Register by sending an email to ePASSProviderRelations@inovalon.com with your name, organization, contact information and the date of the webinar you wish to attend.

 

  • Teleconference: Dial 1-415-655-0002 (US Toll) and enter access code: 736 436 872  
  • WebEx: Visit https://inovalonmeet.webex.com and enter meeting number: 736 436 872
  • Once you join the call, live support is available at any time by dialing *0

 

Alternative reporting engagement

 

ePASS is our preferred method for submission for the Prospective approach. However to improve engagement and collaborate with our Providers who are not submitting via ePASS, we have identified other alternatives which may be helpful and provide more flexibility with your current processes.

 

If you are interested in any of these alternative options, please contact our CRA Network Education Representative: Socorro.Carrasco@anthem.com. Select the attachment to view some of the Alternative Reporting Options.



Featured In:
May 2019 Anthem Blue Cross Provider Newsletter - California