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

We understand the increased risk and strain on the health care system during the fight against COVID-19, and we support you in the response and treatment of your patients. Telehealth is now an option to assess your patients with risk adjustable conditions.  Anthem’s Prospective Risk Adjustment program works to improve risk adjustment accuracy and focus on performing appropriate interventions for patients with undocumented Hierarchical Condition Categories (HCC) in order to help you close your patients’ gaps in care.  This program involves:

 

• Member outreach encouraging primary care physicians (PCP) in-person or telehealth visits.
• Refer to Anthem’s COVID-19 FAQ in Provider News for updates about telehealth reimbursement guidance.

 

• Provider outreach sharing previously coded and suspected conditions, and encouraging member visits

 

• PCP alternatives to complete Health Assessments

 

Inovalon requests

Consistent with 2019, we have again engaged a vendor, Inovalon – an independent company that provides secure, clinical documentation services – to help us comply with the provisions of the Affordable Care Act that require us to assess members’ relative health risk levels.  In the coming weeks and months, Inovalon will begin sending letters to providers as part of a new risk adjustment cycle, asking for your help with completing Health Assessments for some of our members.

If you worked with Inovalon in 2019, many thanks for your help. This year will bring a new round of assessments because chronic conditions must be assessed and coded each and every year. As always, if you have questions about the requests you receive, you can reach Inovalon directly at 1-877-448-8125.

Prospective Program ask of Providers:

• Anthem network providers – usually PCPs – receive letters from Inovalon, requesting that they:

 

1. Schedule a comprehensive in-person or telehealth visit with patients identified by Inovalon 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 SOAP Notes - Subjective, Objective, Assessment and Plan).

 

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

 

• $100 for each Health Assessment properly submitted electronically

 

• $50 for each Health Assessment properly submitted via fax

 

 Submit electronically via Inovalon’s ePASS tool:

 

Inovalon ePASS^® Training Webinars

• Every Wednesday – 3 to 4 p.m. EST

 

Join an ePASS webinar:

• 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.

 

Alternative Engagement

ePASS® is our preferred method for submission. However to improve engagement and collaborate with our providers who are not submitting via ePASS®, we have identified other tools which may be helpful. If in 2019 your practice utilized some of these alternative options for prospective member outreach, we thank you for continuing these alternative forms of program participation into 2020. 

 

For those providers not familiar with our alternative options, they are listed here. Telehealth visits are also an acceptable form of a patient visit for these alternative engagement options. Any questions your office has about these options can be directed to either your local provider representative, or the Anthem CRA network education representative listed below.

• EPHC Providers using PCMS – Providers participating in our Enhanced Personal Health Care (EPHC) program can use member reports from our PCMS tool to schedule members for comprehensive visits. PCMS does have a link to take you directly to the Inovalon ePASS® tool where completed Health Assessments will result in a $100 incentive payment per submitted Health Assessment.

 

• List of Members to be scheduled – Anthem CRA provides member/patient reports for providers to schedule members for comprehensive visits. Providers use normal gap closure through claims submission.  No Health Assessment needed. Not eligible for additional incentive.

 

• EPIC Patient Assessment Form (PAF) – Providers with EPIC as their electronic medical record (EMR) system can fax the EPIC PAF to Inovalon at 1-866-682-6680 with a coversheet indicating "see attached Anthem Progress Note,” which is eligible for a $50 incentive payment.

 

• Providers Existing Patient Assessment Form (PAF) – Utilize providers existing EMR system and applicable PAF. Must be submitted to Inovalon at 1-866-682-6680 with coversheet indicating, "see attached Anthem Progress Note,“ which is eligible for a $50 incentive payment.

 

Please contact our Commercial Risk Adjustment Network Education Representative if you have any questions via email at Socorro.Carrasco@anthem.com.

 

Thank you for your continued efforts with our CRA Program.

Diabetes is a complex chronic illness requiring ongoing patient monitoring. NCQA includes diabetes in its HEDIS® measures on which providers are rating annually. Since diabetes HbA1c, testing is a key measure to assess for future medical conditions related to complications of undiagnosed diabetes, the National Commission for Quality Assurance (NCQA) requires health plans to review claims for diabetes in patient health records.  The findings contribute to health plan stars ratings for Commercial and Medicare plans and the Quality Rating System (QRS) measurement for Marketplace plans. A systematic sample of patient records is pulled annually as part of the HEDIS® medical record review to assess for documentation.

 

Which HEDIS measures are Diabetes Measures?

The diabetes measures focus on members 18-75 years of age with diabetes (type 1 and type 2) who had each of the following assessments:

 

• Hemoglobin A1c (HbA1c) testing
• HbA1c poor control (>9.0%)
• HbA1c control (<8.0%)
• Dilated Retinal exam
• Medical attention for nephropathy

 

The American College of Physicians’ guidelines for people with type 2 diabetes recommend the desired A1c blood sugar control levels remain between 7 to 8 percent.¹

In order to meet the HEDIS measure “HbA1c control <8”, you must document the date the test was performed and the corresponding result. For this reason, report one of the four Category II codes and use the date of service as the date of the test, not the date of the reporting of the Category II code.

To report most recent hemoglobin A1c level hemoglobin A1c level greater than or equal to 8.0% and less than 9.0%, use 3052F. To report most recent A1c level ≤9.0%, use codes 3044F, 3051F, 3052F.²

1. Most recent hemoglobin A1c level less than 7.0% use 3044F
2. Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% use 3051F
3. Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% use 3052F
4. Most recent hemoglobin A1c level greater than 9.0% use 3046F 

NOTE: Multiple dates of service may be associated with a single lab test (e.g., a collection date, a reported date and a claim date). For a laboratory test CPT II code to count toward HEDIS, the Category II date of service and the test result date must be no more than seven days apart.

Continued management and diverse pathways to care are essential in controlling blood glucose and reducing the risk of complications. While it is extremely beneficial for the patient to have continuous management, it also benefits our providers. As HEDIS rates increase, there is potential for the provider to earn maximum or additional revenue through Pay for Quality, Value Based Services, and other pay-for-performance models.³

 

Sources include:

− Diabetes Prevalence: 2015 state diagnosed diabetes prevalence, cdc.gov/diabetes/data; 2012 state undiagnosed diabetes prevalence, Dall et al., ”The Economic Burden of Elevated Blood Glucose Levels in 2012”, Diabetes Care, December 2014, vol. 37.

− Diabetes Incidence: 2015 state diabetes incidence rates, cdc.gov/diabetes/data

− Cost: American Diabetes Association, “Economic Costs of Diabetes in the U.S. in 2017”, Diabetes Care, May 2018.

− Research expenditures: 2017 NIDDK funding, projectreporter.nih.gov; 2017 CDC diabetes funding, www.cdc.gov/fundingprofiles

 

  ¹ https://www.medicalnewstoday.com/articles/321123#An-A1C-of-7-to-8-percent-is-recommended

  ² https://www.ama-assn.org/system/files/2020-01/cpt-cat2-codes-alpha-listing-clinical-topics.pdf

  ³https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-programs/value-based-programs.html 

The Department of Managed Health Care’s (DMHC) routine medical survey includes evaluation of a Health Plan’s compliance with California Health and Safety Code section 1368(a)(2); 28 CCR 1300.68(b)(6) and (7). These regulations require Health Plans to ensure that grievance forms, a description of grievance procedures, and assistance in filing grievances are readily available at each contracting provider’s office, contracting facility, or Plan facility.

 

Please review and distribute the Anthem Blue Cross (Anthem) grievance form to all your participating offices. It is important to implement processes to provide grievance forms and assistance to Anthem members promptly upon request.

 

Your agreement with Anthem requires you to comply with all applicable laws and regulations and to cooperate with Anthem’s administration of its grievance program.

 

Information can be accessed on the process of submitting member grievances and appeals, grievance forms, definitions and appeal rights, on Anthem’s website at www.anthem.com/ca/forms. Go to View by Topic and click on the drop down menu and select Grievance & Appeals, and then select the desired resource link.

 

In addition, grievance forms, grievance procedures, Anthem’s expedited grievance and appeals review process, can be found in Anthem’s Provider Operations’ Manual.

 

Anthem has posted a required learning course via Availity Portal (login required) to ensure provider offices have implemented processes to provide grievance forms and assistance to enrollees. Please make sure to complete this course and the required attestation by June 1, 2020:

 

1. Log in to Availity Portal at com.
2. At the top of Availity Portal, click Payer Spaces > Anthem Blue Cross.
3. On the payer spaces landing page, click Access Your Custom Learning Center from the Applications
4. Search for the Member Grievance Form and Attestation - Online Course using keyword grievance.
5. Enroll and complete the course, including the required attestation module.

Refer to this guide for more information.

 

Not registered for the Availity Portal?

Have your organization’s designated administrator register your organization for the Availity Portal.

1. Visit availity.com to register.
2. Click Register.
3. Select your organization type.
4. In the Registration wizard, follow the prompts to complete the registration for your organization. Refer to these PDF documents for complete registration instructions.

 

Getting Started

When you log in to Availity Portal for the first time, Availity prompts you to:

• Accept privacy and security statements
• Accept a confidentiality agreement
• Choose three security questions and answers
• Create a new password
• Verify your email address

For questions regarding the Availity Portal, please contact Availity Client Services at 1-800-282-4548.

 

We appreciate your cooperation and support.

To ensure timely processing of California (CA) Stop Loss claims, we are seeking your assistance by clearly identifying CA Stop Loss claims.  In addition, please update your records of the new physical address when submitting your stop loss claims. 

 

Anthem Blue Cross

Attn: Hospital Stop Loss Unit

P.O. Box 60007

Los Angeles, California 90060-0007

 

Or

 

Anthem Blue Cross

Attn: Hospital Stop Loss Unit

21215 Burbank Blvd.

Woodland Hills, CA 91367

Anthem Workers’ Compensation, LLC (Anthem) announced a free emergency Telehealth service program in coordination Transparent Health Marketplace (THM), our technology partner for the Anthem Marketplace and with Kura MD, the leading provider of workers’ compensation Telehealth services.  The Kura MD platform gives workers’ compensation providers the means to deliver select healthcare services to injured workers through a secure, HIPAA compliant videoconference on a smart phone, tablet or computer.  As we have all been advised to limit our physical contact with others and are practicing social distancing, this Telehealth platform for physicians comes at an opportune time when more patients are seeking care in alternative ways. Telehealth will assist physicians in providing remote medical assessments, answers to medical questions, prescriptions and physical therapy sessions, and access to behavioral health services for injured workers.  The launch date for this service in California is March 31, 2020, and will expand to other Anthem Workers’ Compensation states soon.

 

To help providers, Anthem has negotiated with Kura MD to offer discounted provider access rates. Now until July 1, 2020, access to the KURA MD platform to render basic telehealth services will be free for a 60-day period from the time they complete their subscription, and providers can select optional additional services at a nominal cost.

 

Providers who are contracted and participate in the Anthem Workers’ Compensation Network, will be able to use the platform with any patient for any plan, network or Payor willing to participate improving access to medical care  for virtually everyone.

 

To subscribe to this emergency program, enroll at https://anthem-wc.com/telehealth.

For the most up-to-date information from Anthem Blue Cross (Anthem) about COVID-19, please bookmark Provider News Home and check back often.  The most recent articles will be displayed in the Provider Spotlight section.

For a repository of all COVID-19 related articles in one location, please reference the COVID-19 Information (California) under Articles by Publication.

Anthem Blue Cross (Anthem) continues to make it easier and more convenient to request consideration for participation as a behavioral health provider. The Digital Provider Enrollment application has been designed to speed up the enrollment process, allow providers to submit data at one time, and obtain real-time updates on the status of an application.

Access to the new application is available through Availity, Anthem’s secure web-based provider portal. New and current Availity users should ensure their user ID has the correct access. Please ensure that you have been assigned to Provider Enrollment.

Digital provider enrollment offers many benefits:

 

• Supports enrollment of professional providers, whose organizations do not have a credentialing delegation agreement with Anthem
• New individual providers or groups can request a contract
• Existing groups can add providers to their existing contract
• Providers can check the status of an application in real-time using the enrollment dashboard

 

To use the new Digital Enrollment application, please confirm your provider data on CAQH is current and in a complete or re-attested status, then log into Availity and use the following navigation: Choose your state > Payer Spaces > Provider Enrollment.

Effective August 1, 2020, Anthem Blue Cross will continue to allow reimbursement for unlisted, unspecified or miscellaneous codes. Unlisted, unspecified or miscellaneous codes should only be used when an established code does not exist to describe the service, procedure or item rendered. Reimbursement is based on review of the unlisted, unspecified or miscellaneous codes on an individual claim basis. Claims submitted with unlisted, unspecified or miscellaneous codes must contain specific information and/or documentation for consideration during review.

 

For additional information, please review the Unlisted, Unspecified or Miscellaneous Codes reimbursement policy here.

 

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Medi-Cal Managed Care (Medi-Cal) members at risk for type 2 diabetes will now have access to the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP). DPP has been proven by the National Institute of Health (NIH) in a randomized controlled trial to greatly reduce the progression of prediabetes to type 2 diabetes.¹ Services are delivered by trained lifestyle coaches and organizations recognized by the CDC.

 

The DPP is a year-long program that consists of weekly sessions with a lifestyle coach for the first six months and monthly maintenance sessions for the latter six months. Sessions can be held in a group classroom setting or online. Participants will learn realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.

 

Members can determine their eligibility for DPP and enroll through our program administrator, Solera Health,* by visiting www.solera4me.com/AnthemBC_MediCal to take the online assessment or by calling 1‑844‑612‑2949 (TTY 711), Monday through Friday from 6 a.m. to 6 p.m. PT.

 

Criteria for eligibility include:

• At least 18 years of age.
• BMI of 25 or greater.
  • If member is of Asian descent, a BMI of 23 or greater is required.
• Blood screening (optional, if available):
  • Hemoglobin A1C: 5.7% to 6.4%
  • Fasting plasma glucose: 100 to 125 mg/dL
  • Oral Glucose Tolerance Test: 140 to 199 mg/dL
• Exclusions include no previous diagnosis of end-stage renal disease or type 1 or type 2 diabetes; not pregnant (previous gestational diabetes is not an exclusion).

 

How to become a DPP provider with the Department of Health Care Services (DHCS):

Enrolled Medi-Cal providers should have one of the following provider types and will need to submit the Medi‑Cal Supplemental Changes Form (DHCS 6209) to DHCS for approval:

• Home health agency
• Physician group
• Physician
• Indian Health services
• Rural health clinic
• Community hospital (outpatient)
• County hospital (outpatient)
• DPP suppliers

 

Once the eligible Medi-Cal provider is approved to become a DPP provider, the provider will receive a newly established category of service (COS) containing the DPP billing codes, as outlined in the request for outsourcing. Only enrolled and eligible Medi-Cal providers who have the DPP COS may bill for DPP services.²

 

To get started, refer qualified patients today to www.solera4me.com/AnthemBC_MediCal!

 

References:

1 https://www.cdc.gov/diabetes/prevention/prediabetes-type2/preventing.html.

2 https://www.dhcs.ca.gov/services/medi-cal/Documents/DPP_OIL_Enclosure_A_Webpage.pdf.

The Department of Health Care Services (DHCS) requires managed care health plans and their contracted providers to implement the age-appropriate Staying Healthy Assessment (SHA) questionnaires.

 

With many offices now using electronic medical records (EMRs), providers can:

• Scan the SHA to use it as an EMR.
• Add the exact SHA questions into an EMR.
• Use the SHA in a different electronic or assessment tool format.
• Use another assessment tool such as Bright Futures.

 

Anthem Blue Cross staff will:

• Work with your office either in person or through email correspondence to review printed screenshots of the electronic SHA to ensure all information from the questionnaires is incorporated word-for-word.
• Confirm that any other assessment tools that offices wish to use include the information that’s on the SHA.
• Submit the appropriate notification form to DHCS at least one month prior to office implementation as required along with the printed screenshots.

 

DHCS requires that providers first notify the health plans by the use of either the SHA Electronic or Other Format Notification Form or Use of Bright Futures Notification Form. These forms can be obtained by calling your local regional health plan at the appropriate phone number below:

• Northern region: 1-888-252-6331
• Central region: 1-559-353-3500
• Southern region: 1-818-291-6914

PCPs and their qualified staff are required to implement tobacco cessation interventions as outlined in the California Department of Health Care Services All Plan Letter 16-014 dated November 30, 2016. These interventions include:

• Conducting initial and annual assessments of all members, of any age, who use tobacco products or are exposed to tobacco smoke, and documenting this information in the member’s medical record. Per the United States Preventive Services Task Force recommendations, this can be accomplished by instituting a tobacco user identification system by: 
  • Using the Staying Healthy Assessment or other individual health education behavior assessments.
  • Adding tobacco use as a vital sign in the chart or electronic health record, or by use of the ICD‑10-CM codes in the medical record-to-record tobacco use. Refer to the Coding Guide for Tobacco Use for codes that can be used.
  • Placing a stamp or sticker on the chart when the member indicates he or she uses tobacco.
• Prescribing FDA-approved tobacco cessation medications to nonpregnant adults of any age. Adults who use tobacco products and are enrolled in Medi-Cal Managed Care (Medi-Cal) are covered for all FDA-approved tobacco cessation medications. This includes over-the-counter medications with a prescription from the provider.
• Referring tobacco users of any age to available individual, group and telephone counseling. Anthem Blue Cross (Anthem) members qualify for four counseling sessions, each for a minimum of 10 minutes, for at least two separate quit attempts each year without prior authorization. Providers can:
  • Use the 5A’s model or other validated behavior change model when counseling members.
  • Refer a member to the CA Smokers Helpline at 1-800-NO-BUTTS (1-800-662-8887) or another equivalent line. The CA Smokers Helpline is available in various languages.
  • Refer to available community programs. For help locating community programs, use the health education referral form located on the provider website at https://mediproviders.anthem.com/ca > Provider Support > Health Education Programs > Health education & cultural and linguistic referral form.
• Asking all pregnant women if they use tobacco or are exposed to tobacco smoke. If they smoke, offer at least one face-to-face counseling session per quit attempt and refer to a tobacco cessation quit line. Counseling services will be covered for 60 days after delivery. Smoking cessation medications are not recommended during pregnancy.
• Providing education, including brief counseling, to school-age children and adolescents to prevent initiation of tobacco.

 

Anthem will monitor provider performance in implementing these tobacco cessation interventions through various processes comprised of medical record review, facility site review, and review of medical or pharmacy claims data.

 

If your office would like tobacco cessation education materials or more information about the revised policy letter, please call the appropriate regional health plan office:

• Northern region: 1-888-252-6331
• Central region: 1-559-353-3500
• Southern region: 1-818-291-6914

Health education classes are available at no charge to Anthem Blue Cross (Anthem) members enrolled in Medi‑Cal Managed Care (Medi-Cal) and are accessible upon self-referral or referral by Anthem network providers. Typically, these classes take place with our hospital and community organization partners; however, one-on-one counseling with a certified health educator is also available.

 

Class availability varies by county. Topics include the following:

• Asthma management
• Childbirth/Lamaze/prenatal education
• Diabetes management
• Injury prevention
• Nutrition, obesity and weight management
• Parenting/well child
• Smoking cessation/tobacco prevention
• Substance use

 

To refer a member to a health education class, just fill out the Health Education Referral form located on the provider website: https://mediproviders.anthem.com/ca/pages/health-education-programs.aspx.

 

Health education materials

Anthem has an extensive selection of health education materials in both English and Spanish for providers and members. Providers can access health education information through the provider website by selecting the Health Education Programs option in the Provider Support webpage or by following this link: https://mss.anthem.com/ca/pages/health-wellness.aspx. Providers can also request additional health education materials through their Network Relations or Quality Management representatives:

• Southern regional office: 1-818-291-6914
• Central regional office: 1-559-353-3500
• Northern regional office: 1-888-252-6331

 

Health education materials may be translated into additional languages upon request. They are also available in alternative formats, including Braille, large print and audio. Contact the Customer Service number on the back of the member card to request these formats. Translations and alternative formats are free of charge.

Free language assistance programs

Our members count on our providers for medical care and treatment; however, they may experience language barriers, which make it difficult to ask questions or communicate their concerns. Anthem is committed to reducing the impact of language barriers for our Medi-Cal patients to obtain language assistance. Providers must notify members of the availability of interpreter services and strongly discourage the use of friends and family, particularly minors, to act as interpreters. Under the federal guidance, published as section 1557 of the Affordable Care Act, providers are required to use qualified interpreters while interacting with members with limited English proficiency.

 

To obtain free interpreting services, please call one of our Medi-Cal Customer Care Centers:

• Inside L.A. County: 1-888-285-7801 (TTY 711)
• Outside L.A. County: 1-800-407-4627 (TTY 1-800-735-2922)

 

It is important that you or your office staff document the member’s language, any refusal of interpreter services, and requests to use a family member or friend as an interpreter in the member’s medical record. Request/Refusal of Interpreter Services forms are available in threshold languages on the Free Interpreting Services page of our website, located at: https://mediproviders.anthem.com/ca/pages/free-interpreting-services.aspx.

 

During regular business hours, providers and members may contact the Medi-Cal Customer Care Center using the number located on the back of the member’s ID card. After hours, the 24/7 NurseLine is available at 1‑800‑224‑0336. When requesting interpreter assistance:

• Give the Customer Care associate the member’s ID number.
• Explain the need for an interpreter and the language required.
• Wait on the line while the connection is made.
• Once connected, the interpreter, an Anthem associate or nurse introduces the Medi-Cal member, explains the reason for the call and begins the dialogue.

 

Providers and members may contact the Medi-Cal Customer Care Center to schedule face-to-face interpreter services for medical appointments during regular business hours. Three business days in advanced notice is required to schedule face-to-face interpreter services. A 24-hour cancellation is required. Providers may also schedule face-to-face interpreter services by sending an email to ssp.interpret@anthem.com and typing secure in the subject line. This is a secure email requiring registration.

 

Members with hearing or speech impairments may use the Medi-Cal Customer Care Center TTY number during regular business hours. After hours, the 24/7 NurseLine TTY number may be used. Members can also use the state relay service line by dialing 711. Customer Care Center associates can also assist non-TTY users who need to contact members who only use TTY equipment, (for example, providers needing to contact members with TTY assistive devices).

 

Members may request health plan materials in alternative formats such as Braille, large print, audio CD, verbal interpretations and non-English languages at no cost by contacting the Medi-Cal Customer Care Center number located on the back of their ID cards.

Effective August 1, 2020, Anthem Blue Cross will continue to allow reimbursement for unlisted, unspecified or miscellaneous codes. Unlisted, unspecified or miscellaneous codes should only be used when an established code does not exist to describe the service, procedure or item rendered. Reimbursement is based on review of the unlisted, unspecified or miscellaneous codes on an individual claim basis. Claims submitted with unlisted, unspecified or miscellaneous codes must contain specific information and/or documentation for consideration during review.

 

For additional information, please review the Unlisted, Unspecified or Miscellaneous Codes reimbursement policy here.

Anthem Blue Cross wants to make multi-dose packaging available to your patients to help support medication adherence. It’s a simpler, safer way for your patients to manage their medications. Multi-dose packaging is a free service available to members at select network pharmacies.

 

What is multi-dose packaging?

Multi-dose packaging (MDP) involves organizing prescription and over-the-counter products to provide ease to patients when taking their routine medications. Each MDP dispenser provides patients with a personalized roll of pre-sorted medication packs, labeled with the date and time of the patient's next scheduled dose. MDP helps reduce the stress of determining which medications to take, when to take them and how much of them to take.

Who provides these services?

MDPs can be shipped to the CVS* retail pharmacy of choice or directly to a patient’s home at no additional charge. The MDP Care team is available 24/7 to address patient questions and concerns. The team also coordinates mid-month prescription changes with local CVS pharmacies. CVS MDP is licensed in all states and the District of Columbia.

 

If CVS is not the right fit based on geography, PillPack* can provide MDP services for your patients. Packages can include prescription medication, over-the-counter medication and vitamins, and will include a date and time stamp on each packet to help your patients remember to take their medications. Patient copays should be the same; in some cases, it may be cheaper.

 

How do I refer my patients to MDP providers?

For CVS: Patients can enroll online at https://www.CVS.com/multidose or call 1-800-753-0596. Patients residing in the District of Columbia, Georgia or South Carolina should call 1-844-650-1637 (due to remote practice restrictions). Members may also enroll at their local CVS pharmacy.

 

For PillPack: Patients interested in PillPack can enroll online at https://www.pillpack.com/blue or via phone by calling 1-866-282-9462.

 

* CVS is an independent company providing pharmacy services on behalf of Anthem Blue Cross. PillPack is an independent company providing pharmacy services on behalf of Anthem Blue Cross.

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Effective August 1, 2020, Anthem Blue Cross will continue to allow reimbursement for unlisted, unspecified or miscellaneous codes. Unlisted, unspecified or miscellaneous codes should only be used when an established code does not exist to describe the service, procedure or item rendered. Reimbursement is based on review of the unlisted, unspecified or miscellaneous codes on an individual claim basis. Claims submitted with unlisted, unspecified or miscellaneous codes must contain specific information and/or documentation for consideration during review.

 

For additional information, please review the Unlisted, Unspecified or Miscellaneous Codes reimbursement policy here.

                                                                                                                                                    

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