 Provider News CaliforniaFebruary 2022 Anthem Blue Cross Provider News - CaliforniaThe Consolidated Appropriations Act (CAA) effective January 1, 2022, contains a provision that requires online provider directory information be reviewed and updated (if needed) at least every 90 days. We are asking you to review your online provider directory information to help ensure Anthem Blue Cross (Anthem) members can locate the most current information for in-network providers and facilities.
You can help us ensure your online provider directory information is current by:
- Reviewing your online provider directory information on a regular basis to ensure it is correct. You can check your directory listing on Anthem’s Find Care tool. Consumers, members, brokers, and providers use the Find Care tool to identify in-network physicians and other healthcare providers supporting member health plans. To ensure we have your most current and accurate information, please take a moment to access Find Care. Go to anthem.com/ca, select Providers, then under Provider Overview, choose Find Care.
- Submitting updates and corrections to your directory information by using our online Provider Maintenance Form. Online update options include:
- add/change an address location
- name change
- tax ID changes
- provider leaving a group or a single location
- phone/fax number changes
- closing a practice location
Once you submit the Provider Maintenance Form, you will receive an email acknowledging receipt of your request. Visit the Provider Maintenance Form landing page for complete instructions.
National Wear Red Day is a great way to keep heart aware. It is also a great opportunity to have a conversation with your patients about their heart health. The Centers for Disease Control and Prevention (CDC) has information you can share with your patients, including a helpful Know the Facts about Heart Disease flyer that’s free for health care professionals.
Controlling high blood pressure, diabetes, extra weight and unhealthy diets are heart disease contributors that you can help your patients recognize. For information about these heart disease risks to share with your patients, use the CDC website for toolkits, flyers and give-a-ways.
Measure Up: Controlling High Blood Pressure (CBP)
Known as the “silent killer,” high blood pressure or hypertension increases the risk of heart disease.
The HEDIS® measure CBP looks at the percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (140/90) in the measurement year. Record all blood pressure readings and the dates they were taken being sure to record the exact reading. Blood pressure readings captured during a telehealth, virtual care, telephone or e-visit should also be recorded.
Measure Up: Statin Therapy for Patients with Cardiovascular Disease and Diabetes (SPC/SPD)
Statins are effective at lowering cholesterol and protecting against a heart attach and stroke. Patients with diabetes also have elevated cardiovascular risk.
- Statin therapy for patients with cardiovascular disease (STC). HEDIS measure assesses males 21-75 years of age and females 40-75 years of age who have clinical atherosclerotic cardiovascular disease and who received and adhered to statin therapy.
- Statin therapy for patients with diabetes (STD) assesses adults 40-75 years of age who have diabetes and who do not have clinical ASCVD, who received and adhered to statin therapy.
Adherence to prescribed medication is key to patient care and SPC/SPD measure success.
EPO Plans and Network
For the 2022 benefit year, Anthem Blue Cross (Anthem) will continue to offer EPO Individual on exchange and off exchange plans in Covered California’s rating regions 1, 7, 9, 10, 12, 13 and 14.
We are also very pleased to announce the expansion of our Individual EPO on and off exchange plans into rating regions 2, 3, 4, 5, 6 and 8. Below is a list of counties located in those regions where Anthem will be offering 2022 EPO on and off exchange Individual plans.
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Rating Region
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County
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1
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Alpine, Amador, Butte, Calaveras, Colusa, Del Norte, Glenn, Humboldt, Lake, Lassen, Mendocino, Modoc, Nevada, Plumas, Shasta, Sierra, Siskiyou, Sutter, Tehama, Trinity, Tuolumne, Yuba
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2
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Marin, Napa, Solano, Sonoma
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3
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El Dorado, Placer, Sacramento, Yolo
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4
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San Francisco
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5
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Contra Costa
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6
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Alameda
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7
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Santa Clara
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8
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San Mateo
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9
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Monterey, San Benito, Santa Cruz
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10
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Mariposa, Merced, San Joaquin, Stanislaus, Tulare
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12
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San Luis Obispo, Santa Barbara, Ventura
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13
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Imperial, Inyo, Mono
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14
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Kern
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Providers in Regions 1, 7, 9, 10, 12, 13 and 14
If you are already participating in the Pathway (on and off exchange) network located in one of these regions, you will continue to provide services to Anthem patients who have purchased coverage on and off exchange as you currently do under your Anthem provider agreement.
Providers in Regions 2, 3, 4, 5, 6 and 8
If you participated in the Pathway (on and off exchange) network in 2017, we have reinstated your participation in the Individual Pathway EPO network under your Anthem provider agreement. We have further extended participation to providers who previously did not participate in the Anthem Individual Pathway EPO network. A communication has been sent to both previously participating providers and new providers in the Pathway EPO network.
HMO Plans and Network
Anthem Blue Cross (Anthem) will continue to offer Individual on and off exchange HMO plans in the below regions in 2022.
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Rating Region
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County
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11
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Fresno, Kings, Madera
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15
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Los Angeles (Northern: High Desert/Antelope Valley and Eastern metropolitan half of county, including San Gabriel Valley)
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16
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Los Angeles (Western and Downtown Los Angeles County, covering the central and southern metropolitan portions of the county)
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17
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Riverside, San Bernardino
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18
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Orange
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These changes do not impact Anthem CA Individual “grandfathered” business.
Anthem appreciates your partnership and continued participation in our Individual Pathway EPO and HMO networks.
If you have questions or need additional information, contact your assigned Provider Experience associate, or visit the Contact Us page on our provider website for up-to-date contact information. Log onto Anthem.com/ca > For Providers > Communications / Contact Us: https://www.anthem.com/ca/provider/contact-us/.
The Cancer Care Navigator (CCN) program is a comprehensive cancer support solution for oncologists and Anthem Blue Cross (Anthem) members who are at high risk for complications during treatment. This program is aimed at helping to simplify the complexities of cancer care for members.
Providers are given a single point of contact to connect the practice to the right people at Anthem to help lessen administrative burdens. CCN also gives the practice access to Anthem’s advanced predictive analytics to help identify patients at high risk for complications, in turn allowing providers the opportunity to take preventive action and guide targeted interventions.
Patients are provided with a wealth of support through supplemental services (dietitians, pharmacists, etc.), medication adherence assistance, individualized care plans, and goal setting, as well as after-hours telephonic and digital support.
CCN is the ultimate support service to improve the care experience and quality of life to allow patients time to focus on overall health and well-being. Please feel free to reach out to the CCN team at 1-833-649-0669.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is an annual standardized survey conducted starting February 2022 through May2022 to assess consumers’ experience with their provider and health plan. A random sample of your adult or child patients may get the survey. Over half of the questions used for scoring are directly impacted by providers. These questions are:
- When you needed care right way, how often did you get care as soon as you needed?
- How often did you get an appointment for a check-up or routine care as soon as you needed?
- How often was it easy to get the care, tests, or treatment you needed?
- How often did you get an appointment to see a specialist as soon as you needed?
- How often did your personal doctor seem informed and up-to-date about the care you got from other doctors or other health providers?
- How would you rate your personal doctor?
- How would you rate the specialist you see most often?
- How would you rate all your health care in the last 6 months?
Interested in how you can improve CAHPS performance? Anthem Blue Cross offers an online course for providers and office staff designed to learn how to improve communication skills, build patient trust and commitment, and expand your knowledge of the CAHPS survey. The Improving the Patient Experience course is available at no cost and is eligible for one CME credit by the American Academy of Family Physicians. It can be accessed at: https://www.mydiversepatients.com/le-ptexp.html.
Visit the Drug Lists page on anthem.com/ca for more information on:
- Copayment/coinsurance requirements and their applicable drug classes
- Drug lists and changes
- Prior authorization criteria
- Procedures for generic substitution
- Therapeutic interchange
- Step therapy or other management methods subject to prescribing decisions
- Any other requirements, restrictions, or limitations that apply to using certain drugs
The commercial and marketplace drug lists are posted to the website quarterly on the first day of the month in January, April, July, and October.
To locate Marketplace formularies and pharmacy information, scroll down to “Select Drug Lists.” This drug list is also reviewed and updated regularly as needed.
FEP Pharmacy updates and other pharmacy related information may be accessed at www.fepblue.org > Pharmacy Benefits.
This communication applies to the Medicaid, Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).
Effective November 1, 2021, EnrollSafe* at https://enrollsafe.payeehub.org replaced
Enrollhub® from the Council for Affordable Quality Healthcare, Inc. (CAQH) as the electronic funds transfer (EFT) enrollment website at no cost to Anthem Blue Cross providers.
EnrollSafe is safe, secure, and available 24-hours a day
Log onto the EnrollSafe enrollment hub at https://enrollsafe.payeehub.org to enroll in EFT. You will be directed through the EnrollSafe secure website to the Registration page, where you will provide the required information to create an account and then Enroll to supply your banking information.
Already enrolled in EFT through CAQH Enrollhub?
If you were previously enrolled in EFT through CAQH Enrollhub, no action is needed unless you are making changes. Your EFT enrollment information will not change as a result of the new enrollment hub.
If you have changes to make, use https://enrollsafe.payeehub.org to update your account.
For more information or additional questions regarding the EnrollSafe Enrollment Hub portal, the provider can contact the Support team by calling 877-882-0384, Monday through Friday 9 a.m. to 8 p.m. ET.
This communication applies to the Medicaid, Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).
Effective November 1, 2021, EnrollSafe* at https://enrollsafe.payeehub.org replaced
Enrollhub® from the Council for Affordable Quality Healthcare, Inc. (CAQH) as the electronic funds transfer (EFT) enrollment website at no cost to Anthem Blue Cross providers.
EnrollSafe is safe, secure, and available 24-hours a day
Log onto the EnrollSafe enrollment hub at https://enrollsafe.payeehub.org to enroll in EFT. You will be directed through the EnrollSafe secure website to the Registration page, where you will provide the required information to create an account and then Enroll to supply your banking information.
Already enrolled in EFT through CAQH Enrollhub?
If you were previously enrolled in EFT through CAQH Enrollhub, no action is needed unless you are making changes. Your EFT enrollment information will not change as a result of the new enrollment hub.
If you have changes to make, use https://enrollsafe.payeehub.org to update your account.
For more information or additional questions regarding the EnrollSafe Enrollment Hub portal, the provider can contact the Support team by calling 877-882-0384, Monday through Friday 9 a.m. to 8 p.m. ET.
This communication applies to the Medicaid, Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).
Effective November 1, 2021, EnrollSafe* at https://enrollsafe.payeehub.org replaced
Enrollhub® from the Council for Affordable Quality Healthcare, Inc. (CAQH) as the electronic funds transfer (EFT) enrollment website at no cost to Anthem Blue Cross providers.
EnrollSafe is safe, secure, and available 24-hours a day
Log onto the EnrollSafe enrollment hub at https://enrollsafe.payeehub.org to enroll in EFT. You will be directed through the EnrollSafe secure website to the Registration page, where you will provide the required information to create an account and then Enroll to supply your banking information.
Already enrolled in EFT through CAQH Enrollhub?
If you were previously enrolled in EFT through CAQH Enrollhub, no action is needed unless you are making changes. Your EFT enrollment information will not change as a result of the new enrollment hub.
If you have changes to make, use https://enrollsafe.payeehub.org to update your account.
For more information or additional questions regarding the EnrollSafe Enrollment Hub portal, the provider can contact the Support team by calling 877-882-0384, Monday through Friday 9 a.m. to 8 p.m. ET.
*EnrollSafe is a tool developed by Zelis Payments, an independent organization offering electronic fund transfer services on behalf of Anthem Blue Cross.
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