In January 2021, Anthem Blue Cross (Anthem) launched BlueHPN® to keep pace with the rapidly evolving nature of healthcare, and to answer the call from our national employer groups to improve health outcomes and affordability of care for their organizations and employees.  BlueHPN is part of a national network of Blue High-Performance networks being created in collaboration with the Blue Cross Blue Shield Association.

Effective January 1, 2022, in California, Anthem’s BlueHPN includes new counties. The larger network area will be comprised of seven metropolitan service areas located in Northern and Southern California:

• Sacramento-Roseville-Arden-Arcade
• San Francisco-Oakland-Hayward-Solano-Sonoma
• San Jose-Sunnyvale-Santa Clara
• Los Angeles-Long Beach-Anaheim-Ventura
• San Diego-Carlsbad
• Riverside-San Bernardino-Ontario
• Merced-San Joaquin-Stanislaus

Member ID cards and other plan material(s) feature one small change for 2022: BlueHPN is now a single word rather than two. 

Please note that all providers and facilities behavioral health-specific contracts, birthing centers, imaging providers, and all of the ancillary provider types listed below are included in Anthem’s BlueHPN:

• DME/O&P/Mail Order Disposable Supply (DMEPOS)
• Cardiac Event Monitoring (CEM)
• Home/Ambulatory Infusion/Immunization
• Skilled Nursing Facilities (Free Standing only)
• Reference Labs
• Therapies (PT, OT, ST)
• Audiologist
• Hearing Aid Providers
• Registered Dietitians
• Acupuncturists
• Home Health Agency (HHA)
• Hospice
• Dialysis Facilities
• Ground and Air Ambulance

BlueHPN participation is displayed in provider profiles in our provider directory. 

Below is a sample ID card of a fictional member from California enrolled in the national employer Blue HPN plan. Note the new “Blue High-Performance Network” logo and “BlueHPN” indicator in the suitcase icon.




1490-0122-PN-CA

The medical claims and customer service administrator for Butte Schools, located in Butte County, is changing from Anthem Blue Cross to AmeriBen effective January 1, 2022. AmeriBen will be responsible for the administration of benefits, including claims payment, benefit inquiries and appeals. Be sure to verify each members ID card prior to verifying benefits/eligibility and to obtain information on claim submission.

1489-0122-PN-CA

Parents may not understand the importance of taking their children to the doctor when they are healthy. The benefits are documented by the American Academy of Pediatrics¹ as well as the Centers for Disease Control and Prevention² and it all starts with a recommendation by you, the trusted physician. Share these benefits with parents during regularly scheduled well-visits, or even during sick visits, to reinforce the importance of staying on track:

• Regular wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.
• Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.
• Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.
• Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.

Measure up: Well-Child Visits in the first 30 months of life (W30)

This HEDIS® measure is described as the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months. These rates are reported:

• Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.
• Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.

Tips

• Telehealth visits are acceptable in meeting the measurement requirements.
• Consider scheduling well-child visits in advance of the child reaching the age for the visit.

Coding

• ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2
• HCPCS: G0438-G0439, S0302
• CPT: 99381-99382, 99391-99392, 99461

1Parent Plus: Importance of routine pediatrician visits. American Academy of Pediatrics. https://publications.aap.org/aapnews/news/12481?autologincheck=redirected

2Catch up on well-child visits and recommended vaccinations. Centers for Disease Control and prevention. cdc.gov/vaccines/parents/visit/vaccination-during-COVID-19.html 
1509-0122-PN-CA

Effective January 1, 2022, IngenioRx/CVS Specialty Pharmacy* will no longer distribute the brand name drug Botox^®. However, Botox will still be available to Anthem Blue Cross members through other vendors.

Please note:

• This is not a change in member benefits. This is a change in the Botox vendor only.
• If the member is not using IngenioRx/CVS Specialty Pharmacy to obtain Botox, no action is needed.

For Botox managed under a Medicare member’s part B (medical) benefit

Providers should be using buy and bill for any Medicare member who currently receive Botox through their part B (medical) benefit.  If your patient is receiving Botox using their part B benefit and is receiving their prescription from IngenioRx/CVS Specialty pharmacy, effective January 1, 2022, IngenioRx/CVS Specialty will no longer filled the prescription. As of January 1, 2022, you will need to buy this drug and bill your patient’s health plan.

If you have questions regarding a Medicare member’s part B benefits, call Provider Services using the information on the back of the member’s ID card.

For Botox managed under a Medicare member’s part D (pharmacy) benefit

Effective January 1, 2022, Medicare members who currently receive Botox through IngenioRx/CVS Specialty Pharmacy using their part D (pharmacy) benefit must change to another in-network specialty or retail pharmacy that can obtain and dispense Botox.

If you have questions regarding a Medicare member’s part D benefit, call Pharmacy Member Services using the information on the back of the member’s ID card.

* IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem Blue Cross. CVS is an independent company providing pharmacy services on behalf of Anthem Blue Cross.
ABCCRNU-0212-21

Please continue to check for important Cal MediConnect updates at https://providers.anthem.com/california-provider/communications/news-and-announcements for the latest Cal MediConnect information, including:

• Medical step therapy updates

Effective for dates of service on and after April 1, 2022, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.

Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

ACADPEC-774-21

This communication applies to the Medicaid, Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).

The HEDIS^® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care services. 

The ECDS Reporting Standard provides a method to collect, and report structured electronic clinical data for HEDIS quality measurement and improvement. 

Benefits to providers:

• Reduced burden of medical record review for quality reporting
• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

Learn more about NCQA’s digital quality system and what it means to you and your practice, at the following link: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

ECDS measures

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure.  In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

For HEDIS measurement year 2022, the following measures can be reported using ECDS: 

• Childhood Immunization Status (CIS-E) *
• Immunizations for Adolescents (IMA-E) *
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E) *
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

* Indicates that this is the first year that the measure can be reported using ECDS

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening and Follow-up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

* HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
ACA-NU-0396-21

Effective January 1, 2022, IngenioRx/CVS Specialty Pharmacy* will no longer distribute the brand name drug Botox^®. However, Botox will still be available to Anthem Blue Cross members through other vendors.

Please note:

• This is not a change in member benefits. This is a change in the Botox vendor only.
• If the member is not using IngenioRx/CVS Specialty Pharmacy to obtain Botox, no action is needed.

For Botox managed under a Medicare member’s part B (medical) benefit

Providers should be using buy and bill for any Medicare member who currently receive Botox through their part B (medical) benefit.  If your patient is receiving Botox using their part B benefit and is receiving their prescription from IngenioRx/CVS Specialty pharmacy, effective January 1, 2022, IngenioRx/CVS Specialty will no longer filled the prescription. As of January 1, 2022, you will need to buy this drug and bill your patient’s health plan.

If you have questions regarding a Medicare member’s part B benefits, call Provider Services using the information on the back of the member’s ID card.

For Botox managed under a Medicare member’s part D (pharmacy) benefit

Effective January 1, 2022, Medicare members who currently receive Botox through IngenioRx/CVS Specialty Pharmacy using their part D (pharmacy) benefit must change to another in-network specialty or retail pharmacy that can obtain and dispense Botox.

If you have questions regarding a Medicare member’s part D benefit, call Pharmacy Member Services using the information on the back of the member’s ID card.

ACAD-NU-0176-21

Please continue to check for important Medicare Advantage updates at https://www.anthem.com/ca/provider/medicare-advantage/ for the latest Medicare Advantage information, including:

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines update

• Medical step therapy updates

• Anthem Blue Cross expands specialty pharmacy precertification list

This communication applies to the Medicaid, Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).

The HEDIS^® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care services. 

The ECDS Reporting Standard provides a method to collect, and report structured electronic clinical data for HEDIS quality measurement and improvement. 

Benefits to providers:

• Reduced burden of medical record review for quality reporting
• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

Learn more about NCQA’s digital quality system and what it means to you and your practice, at the following link: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

ECDS measures

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure.  In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

For HEDIS measurement year 2022, the following measures can be reported using ECDS: 

• Childhood Immunization Status (CIS-E) *
• Immunizations for Adolescents (IMA-E) *
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E) *
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

* Indicates that this is the first year that the measure can be reported using ECDS

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening and Follow-up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

* HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

ACA-NU-0396-21

Effective December 1, 2021, Anthem Blue Cross (Anthem) will prefer the referring physician name and NPI to be included on professional claims for home infusion therapy (HIT) services in fields 17 and 17a on the CMS-1500 Claim Form.

Providers should report the referring physician information in accordance with the Anthem guidelines in the Electronic Data Interchange (EDI) Companion Guide for claims submitted electronically.

Thank you for your assistance in our ongoing efforts to promote accurate claims processing and payment. We continue to be dedicated to delivering access to quality care for our members, providing higher value to our customers, and helping improve the health of our communities.

If you have questions regarding this process, contact your Network Manager.

ABCCRNU-0211-21

Effective January 1, 2022, Northern California Cement Masons in California will offer an Anthem Blue Cross (Anthem) Medicare Preferred (PPO) plan. Anthem will provide medical benefits for Northern California Cement Masons retirees through the Preferred Provider Organization (PPO) product, which includes the National Access Plus benefit. The PPO plan allows members to receive services from any provider, as long as the provider is eligible to receive payments from Medicare.

Northern California Cement Masons members’ copay or coinsurance percentage will be the same whether their provider is in- or out-of-network. Locally or nationwide, doctors or hospitals, member share-of-cost (SOC) doesn’t change.

Noncontracted providers may continue treating Northern California Cement Masons members and will be reimbursed 100% of Medicare’s allowed amount for covered services, less any member SOC.

The Medicare Advantage plan offers the same hospital and medical benefits that Medicare covers, while covering additional benefits that Medicare does not, such as LiveHealth Online* and SilverSneakers. *

The prefix on the Medicare Advantage ID cards is MBL.

Prior authorization requirements are also available to contracted providers by accessing the Provider Self-Service Tool on the Availity* Portal at https://www.availity.com.

Providers will follow their normal claim filing procedures for Northern California Cement Masons member claims.

Providers may call the number on the back of the member’s ID card for eligibility, prior authorization requirements, and any questions about the Northern California Cement Masons member benefits or coverage.

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross. Tivity Health, Inc. is an independent company providing the SilverSneakers fitness program on behalf of Anthem Blue Cross. LiveHealth Online is the trade name of Health Management Corporation, an independent company, providing telehealth services on behalf of Anthem Blue Cross.
ABCCRNU-0215-21

Effective January 1, 2022, Los Angeles City Employees' Retirement System (LACERS) in California will offer an Anthem Blue Cross (Anthem) Medicare Preferred (PPO) plan. Anthem will provide medical benefits for LACERS retirees through the Preferred Provider Organization (PPO) product, which includes the National Access Plus benefit.

The PPO plan allows members to receive services from any provider, as long as the provider is eligible to receive payments from Medicare.

LACERS members’ copay or coinsurance percentage will be the same whether their provider is in- or out-of-network. Locally or nationwide, doctors or hospitals, member share-of-cost (SOC) doesn’t change.

Noncontracted providers may continue treating LACERS members and will be reimbursed 100% of Medicare’s allowed amount for covered services, less any member SOC.

The Medicare Advantage plan offers the same hospital and medical benefits that Medicare covers, while covering additional benefits that Medicare does not such as LiveHealth Online* and SilverSneakers. *

The prefix on the Medicare Advantage ID cards is MBL.

Prior authorization requirements are also available to contracted providers by accessing the Provider

Self-Service Tool on the Availity* Portal at https://www.availity.com.

Providers will follow their normal claim filing procedures for LACERS member claims.

Providers may call the number on the back of the member’s ID card for eligibility, prior authorization requirements, and any questions about the LACERS member benefits or coverage.

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross. Tivity Health, Inc. is an independent company providing the SilverSneakers fitness program on behalf of Anthem Blue Cross. LiveHealth Online is the trade name of Health Management Corporation, an independent company, providing telehealth services on behalf of Anthem Blue Cross.
ABCCRNU-0214-21

Please continue to check for important Medi-Cal Managed Care updates at https://providers.anthem.com/california-provider/communications/news-and-announcements for the latest Medi-Cal Managed Care information, including:

• Pharmacy services to be fee-for-service benefit

• Prior authorization updates for medications billed under the medical benefit

This communication applies to the Medicaid, Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).

The HEDIS^® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care services. 

The ECDS Reporting Standard provides a method to collect, and report structured electronic clinical data for HEDIS quality measurement and improvement. 

Benefits to providers:

• Reduced burden of medical record review for quality reporting
• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

Learn more about NCQA’s digital quality system and what it means to you and your practice, at the following link: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

ECDS measures

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure.  In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

For HEDIS measurement year 2022, the following measures can be reported using ECDS: 

• Childhood Immunization Status (CIS-E) *
• Immunizations for Adolescents (IMA-E) *
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E) *
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

* Indicates that this is the first year that the measure can be reported using ECDS

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening and Follow-up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

* HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
ACA-NU-0396-21

Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) is an annual standardized survey conducted between January and May to assess consumer experiences with their provider and health plan, received by a random sample of patients. We use the results to measure our performance against our goals and determine the effectiveness of actions implemented to improve.


Providers directly affect over half of the questions used for scoring. Anthem Blue Cross offers an online course for providers and office staff designed to teach 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 continuing medical education (CME) credit by the American Academy of Family Physicians. Providers can access the course at https://www.mydiversepatients.com/le-ptexp.html.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).
ACA-NU-0399-21

Effective January 1, 2022, CVS Specialty Pharmacy and IngenioRx Specialty Pharmacy will no longer distribute the brand name drug Botox®, but it will still be available to Anthem Blue Cross (Anthem) members through buy and bill.

Please note:

• This is not a change in member benefits. This is a change in the Botox vendor only.
• If the member is not using CVS Specialty Pharmacy or IngenioRx Specialty Pharmacy to obtain Botox, no action is needed.

For Botox managed under a member’s medical benefit

Effective January 1, 2022, you will need to buy this drug and bill Anthem.

If you have questions regarding a member’s medical specialty pharmacy benefits, call one of our
Medi-Cal Customer Care Centers at 800-407-4627 (outside L.A. County) or 888-285-7801 (inside Los Angeles County). For L.A. Care only: 888-285-7801.

ACA-NU-0394-21