 Provider News CaliforniaFebruary 2020 Anthem Blue Cross Provider News - CaliforniaAnthem Blue Cross (Anthem) announced in July that the AIM Rehabilitative Program was delayed. As previously communicated the program was delayed due to some continued group membership, provider status, and system issues experienced by the Rehab program. Although many of the issues have been resolved, the program remains temporarily delayed to continue to enhance data and processes and will not go live the first quarter of 2020 for fully insured or ASO members. There is no change in any other process or program. Processes have been put in place to allow providers to continue to provide treatment and allow claims to process. Claims that were denied for no authorization in error after July 1, 2019, will reprocess. Coverage for PT/ST/OT visits with dates of service July 1, 2019 and thereafter will not require a prior authorization until further notice. We anticipate the program will relaunch later in 2020. Please access the AIM ProviderPortal or the Anthem electronic newsletters for the exact date. We will let you know when we have a new implementation date. Please note that if you are providing PT/OT/ST services to an Anthem Commercial member whose state of issuance is part of the AIM Rehab Program, you will be required to obtain an authorization.
Anthem is also transitioning vendors for review of Rehabilitative Services for our Medicare members to include out-patient PT, OT, and SLP, to AIM Specialty Health. The AIM Rehab program will now begin in April 2020. Prior authorization will not be required for the above mentioned services through March 2020.
Please be sure to check upcoming editions of Provider News for more information about the AIM Rehabilitative Program for Medicare members. Anthem Blue Cross (Anthem) has network leasing arrangements with a variety of organizations, which we call Other Payors. Other payors and affiliates use the Anthem network.
Under the terms of your provider agreement, members of other payors and affiliates are treated like Anthem members. As such, they’re entitled to the same Anthem billing considerations, including discounts and freedom from balance billing. You can obtain the Other Payors list on the Availity web portal, at www.Availity.com. From the Availity site, select Home > Anthem California > Education and Reference Center, or email us at CAContractSupport@Anthem.com. Anthem Blue Cross (Anthem) providers should now submit changes to their practice profile using our online Provider Maintenance Form.
Online update options include: add an address location, name change, tax ID changes, provider leaving a group or a single location, phone/fax numbers, closing a practice location, etc. Visit the Provider Maintenance Form landing page to review more.
The new online form can be found the redesigned provider site www.anthem.com/ca, select the Providers tab then select Provider Maintenance Form in the sub bullets. In addition, the Provider Maintenance Form can be accessed through the Availity Web Portal by selecting California> Payer Spaces-Anthem Blue Cross> Resources tab >Provider Maintenance Form.
Important information about updating your practice profile:
- Change request should be submitted using the online Provider Maintenance Form
- Submit the change request online. No need to print, complete and mail, fax or email demographic updates
- You will receive an auto-reply e-mail acknowledging receipt of your request and another email when your submission has been processed
- For change(s) that require submission of an updated IRS Form w-9 or other documentation, attach them to the form prior to submitting
- Change request should be submitted with advance notice
- Contractual agreement guidelines may supersede effective date of request
You can check your directory listing on the Anthem Blue Cross: “Find a Doctor tool”. The Find a Doctor tool at Anthem is used by consumers, members, brokers, and providers to identify in-network physicians and other health care providers supporting member health plans. To ensure Anthem has the most current and accurate information, please take a moment to access the Find A Doctor tool (www.anthem.com/ca, select the Providers tab, then select the Find A Doctor in the sub bullets) and review how you and your practice are being displayed. It is extremely important that we have accurate and up-to-date information about your practice in our directories. Senate Bill 137 (SB 137), requires that Anthem Blue Cross (Anthem) provide our members accurate and up-to-date provider directory data. As a result, Anthem will be conducting ongoing outreaches to all practices to confirm the information we have on file is accurate. Without verification from you that our Provider Directory information is accurate, we will be required to remove your practice from the directories we make available to our members. We appreciate your attention to this matter. Anthem Commercial Risk Adjustment (CRA) contracts with Inovalon -- an independent company that provides secure, clinical documentation services -- to help us comply with provisions of the Affordable Care Act (ACA) that require us to assess members’ relative health risk level and report to CMS on those conditions. Your offices have been receiving Inovalon SOAP (Subjective; Objective; Assessment; and Plan – these are health assessments) packets all year long as part of our risk adjustment cycle, asking for the physicians’ help with completing health assessments for some of their patients who are our members.
Incentives for submitting SOAP’s/Health Assessments
SOAPs submitted as paper are eligible for a $50 incentive; SOAPs submitted electronically through Inovalon’s ePASS system are eligible for a $100 incentive.
Submission Deadline and Important Reminder
While the dates of service for the patient visits must have been by December 31, 2019, the SOAP notes/Health Assessments can be submitted up until February 15, 2020. We will still pay the incentive payments for these submissions through February 15, 2020.
Questions or assistance with SOAPs
Need help with ePASS or have questions? Simply email your inquiry to Inovalon at ePASSsupport@inovalon.com with your name, organization, contact information, and any questions that you might have. Trained representatives are available to assist you. If you prefer to reach Inovalon by phone, please call 1-877-448-8125, Monday - Friday, 8 am - 9 pm ET; Saturday - Sunday, 10 am - 6 pm ET.
If you have any questions regarding our risk adjustment process, please contact our CRA Network Education Representative who supports your area: Socorro.Carrasco@anthem.com. Anthem Blue Cross’ parent company is collaborating with leading organizations on a new school-based initiative called Shine Light on Depression to help tackle the issue of teen depression and suicide in middle and high school youth nationwide. The Shine Light on Depression e-toolkit (e.g., website) will provide school communities with free, ready-to-use tools designed to raise awareness of depression and suicide prevention in a positive, fact-based, and inclusive manner. This approach will help build a community in which there is open discussion and appropriate vocabulary about the subject of depression and places it in the broader context of good mental health. The e-toolkit features customizable classroom lessons to empower educators to lead effective depression awareness programs, family-community workshop materials to help adults and families talk about how to support teens, and teen club resources that empower students to lead activities and help each other by talking and listening. With 24,053 secondary schools in the U.S., the Shine Light on Depression e-toolkit has the potential to impact large numbers of individuals who are at risk of depression and suicide and may support schools in meeting state teaching mandates. Visit Shine Light on Depression to learn more.
Shine Light on Depression is a unique collaboration of organizations committed to raising awareness of depression and suicide prevention among young people: American School Health Association, Anthem, Inc., Erika’s Lighthouse, JetBlue Airways Corporation, and the National Parent Teachers Association. Correction: In the January 2020 Provider News there was an incorrect URL in the article ‘An exclusive invitation for providers to subscribe to the Anthem Marketplace for Workers’ Compensation”. For ease of readability we are publishing it again and have made the necessary corrections to the URL below.
Join the movement today!
As a current Anthem therapy provider, you should have received in the mail your exclusive invitation in January to subscribe to the Anthem Marketplace, powered by Transparent Health Marketplace™ (THM). This revolutionary marketplace is not like a traditional PPO. It’s a connected end-to-end technology platform that incorporates familiar ways of electronically transacting business. If you already started your subscription we will send you an email link to make completing it a breeze!
It’s quick, easy and only takes “one click” to connect to new patients!
Subscribing is easy! Visit us today at: www.anthem-wc.com/oneclick/invite (updated link)
PS: Freestanding Imaging providers invitations are coming soon!
With several national payor partners signed up and hundreds of providers already subscribed, the platform has experienced triple-digit growth in select California markets. Now, we are launching statewide in California. We hope you will embrace our movement, love our platform, tell your friends and colleagues, take back control of your practice, and help us lead the transformation of the workers’ compensation system. Are you in?
Category: Cal MediConnect
Anthem Blue Cross (Anthem) has updated the split-care modifier percentages.
Currently, Anthem allows reimbursement of surgical codes appended with split-care modifiers. Reimbursement is based on the following percentages:
- Modifier 54 (surgical care only): 70%
- Modifier 55 (postoperative management only): 30%
Separate reimbursement for Modifier 56 is not allowed.
Effective May 1, 2020, Anthem will continue to allow reimbursement of surgical codes appended with split-care modifiers reimbursement, but reimbursement will be based on the following percentages:
- Modifier 54 (surgical care only): 80%
- Modifier 55 (postoperative management only): 20%
Separate reimbursement for Modifier 56 is not allowed.
Please visit https://mediproviders.anthem.com/ca to view the Split-Care Surgical Modifiers reimbursement policy for additional information regarding percentages and reimbursement criteria.
Category: Medi-Cal Managed Care
As patient panels grow more diverse and needs become more complex, providers and office staff need more support to help address patients’ needs. Anthem Blue Cross (Anthem) wants to help.
Cultural competency resources
We have cultural competency resources available on our provider website. Leveraging content created by the Industry Collaboration Effort (ICE) Cultural and Linguistic Workgroup, the Cultural Competency Training and the Caring for Diverse Populations Toolkit have enhanced content.
- Cultural Competency Training includes:
- Enhanced content regarding culture including language and the impact on health care.
- A cultural competency continuum that can help providers assess their level of cultural competency.
- Guidance on working effectively with interpreters.
- Comprehensive content on serving patients with disabilities.
- Caring for Diverse Populations Toolkit includes:
- Comprehensive information on working with diverse patients and effectively supporting culture, language and disabilities in health care delivery.
- Tools and resources to help mitigate barriers including materials that can be printed and made available for patients in your office.
- Guidance on regulations and standards for cultural and linguistic services.
In addition, providers can access https://mydiversepatients.com for tools and resources that are accessible from any smartphone, tablet or desktop. Providers will find free continuing medical education courses that cover topics relevant to providing culturally competent care and services for diverse individuals.
Prevalent non-English languages (based on population data)
Like you, Anthem wants to effectively serve the needs of diverse patients. It’s important for us all to be aware of the cultural and linguistic needs of our communities, so we are sharing recent data about the prevalent non-English languages spoken by 5 percent or 1,000 individuals in California. (Source: American Community Survey, 2016 American Community Survey 5-Year Estimates, Table B16001, generated 10/03/2018)
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Prevalent non-English languages in CA
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Arabic
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Persian
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Armenian
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Russian
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Chinese
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Spanish or Spanish Creole
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Hmong
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Tagalog
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Korean
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Thai, Lao or other Tai-Kadai
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Khmer
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Vietnamese
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Language support services
As a reminder, Anthem provides language support services for our members with limited English proficiency (LEP) or hearing, speech or visual impairments. Please see the provider manual at https://mediproviders.anthem.com/ca for details on the available services and how to access them.
Category: Medi-Cal Managed Care
Click here for more information about the Regulatory updates. Category: Medicare
In 2020, Anthem Blue Cross (Anthem) will offer an institutional special needs plan (I-SNP), Anthem MediBlue Care On Site (HMO I-SNP), focused on qualified members living in skilled nursing facilities or assisted living centers. The plan aims to improve access to care and communication with members, family, staff and providers while working alongside PCPs to ensure the best possible outcomes for the member.
Anthem will collaborate with CareMore Health mobile clinicians in the community to deliver a high-touch, well-coordinated, holistic model of care to institutionalized patients at the member’s bedside.
In addition to our contracted mobile providers, the plan includes Anthem-contracted Medicare Advantage HMO fee-for-service providers.
Additionally, Anthem and CareMore Health will offer a chronic special needs plan (C-SNP): Anthem MediBlue Diabetes (HMO C-SNP). This plan will focus on providing the best care to members with diabetes. The plan is designed to:
- Address the greater incidence of chronic disease and disability in the dual-eligible and Medicare-only populations.
- Enhance the coordination of a member’s long-term care, primary and acute care, and prescription drug benefits through a unified case management program.
Members are eligible for a Healthy Start appointment where providers will complete a Health Risk Assessment (HRA). After completing the HRA, CareMore Health clinicians will collaborate with the member’s PCP to design an Individualized Care Plan.
Prior authorization requirements will be different from our other Medicare Advantage products. When reviewing prior authorization requirements, select Medicare I-SNP C-SNP from the drop-down box on the provider website.
To learn more about our plans, visit http://www.anthem.com/ca/medicareprovider or call the number on the back of the member ID card. To become a participating Medicare Advantage HMO provider for these plans, contact your Provider Relations representative.
506920CAPENABC Category: Medicare
CMS requires that all hospitals and critical access hospitals (CAHs) provide written notification and an oral explanation to individuals receiving observation services as outpatients for more than 24 hours.
Hospitals should use the OMB-approved standardized Medicare Outpatient Observation Notice (MOON), form CMS-10611. All hospitals and CAHs are still required to provide this statutorily required notification. The notice and accompanying instructions are available at https://go.cms.gov/391jZH9.
The MOON was developed to inform all Medicare beneficiaries, including Anthem Blue Cross members, when they are an outpatient receiving observation services, and are not an inpatient of the hospital or CAH. The notice must include the reasons the individual is an outpatient receiving observation services and the implications of receiving outpatient services, such as required Medicare cost-sharing and post-hospitalization eligibility for Medicare coverage of skilled nursing facility services.
Hospitals and CAHs must deliver the notice no later than 36 hours after observation services are initiated or sooner if the individual is transferred, discharged or admitted.
506979MUPENMUB Category: Medicare
Effective May 1, 2020, Anthem Blue Cross (Anthem) has updated the Modifier 62: Co‑Surgeons reimbursement policy to expand the current policy’s language, adding that Anthem does not consider surgeons performing different procedures during the same surgical session as co-surgeons, and Modifier 62 is not required.
Assistant surgeon and/or multiple procedures rules and fee reductions apply if a co-surgeon acts as an assistant in performing additional procedure(s) during the same surgical session.
Please note that assistant surgeon rules do not apply to procedures appropriately billed with Modifier 62.
Please visit www.anthem.com/ca/medicareprovider to view the Modifier 62: Co-Surgeons reimbursement policy for additional information regarding percentages and reimbursement criteria.
501926MUPENMUB |