Moving Toward Equity in Asthma Care
Anthem Blue Cross is committed to achieving health equity in asthma outcomes with diverse populations. As part of this commitment, we offer an online training, Moving Toward Equity in Asthma Care. This course is accessible from any mobile device or computer and provides one continuing medical education credit at no cost to you. Visit www.mydiversepatients.com.

Asthma Medication Ratio (AMR) HEDIS^® measure 
The National Committee for Quality Assurance (NCQA) is also working to identify and reduce disparities in care. As part of this effort, race and ethnicity stratifications were added to the AMR HEDIS metric this year. The AMR metric measures the percentage of members 5 to 64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.5 or greater during the measurement year.

Did you know: 

• Hispanics and African Americans with asthma are less likely to take daily controllers and are more likely to visit the ER and be hospitalized for asthma-related conditions than non-Hispanic whites? ¹
• Asian Americans are more likely to die from asthma than non-Hispanic whites?²
• Appropriate medication management for patients with asthma could reduce the need for rescue medication — as well as the costs associated with ER visits, inpatient admissions, and missed days of work or school?

Helpful tips: 

• Ensure at least half of the medications dispensed to treat asthma are controller medications throughout the measurement period. 
• Talk to the patient about the importance of controller medication compliance, and not to use rescue medications on a regular basis, unless part of asthma action plan.
• Encourage patients to fill their prescriptions on a regular schedule rather than waiting till they are symptomatic.
• Create a written asthma action plan in language the patient understands, and schedule follow-up appointments with patients. Ask patients questions to assess asthma control, adherence to the action plan, and identify
• Utilize evidence-based asthma assessment tools to assess asthma control, adherence to the action plan, and identify triggers.
• Take the Moving Toward Equity in Asthma Care CME course at no cost for more helpful tips.

Additional resources
Also available is the Asthma & Me training. Do your patients have asthma? Show them the pathophysiology of asthma in their preferred language.

References:

1. Asthma and Allergy Foundation of America & National Pharmaceutical Council. (2005). Ethnic Disparities in the Burden and Treatment of Asthma. Retrieved from http://www.aafa.org/media/Ethnic-Disparities-Burden-Treatment-Asthma-Report.pdf
2. U.S. Department of Health & Human Service, Office of Minority Health. (2016, May 9). Asthma and Asian Americans. Retrieved August 8, 2016, from https://www.minorityhealth.hhs.gov
3. Asthma and Allergy Foundation of America. (2020). Asthma Disparities in America: A Roadmap to Reducing Burden on Racial and Ethnic Minorities. Retrieved from: https://aafa.org/wp-content/uploads/2022/08/asthma-disparities-in-america-burden-on-racial-ethnic-minorities.pdf

CABC-CM-019713-23-CPN18979

We’re committed to being actively involved with our care provider partners and going beyond the contract to create a real impact on the health of our communities. That’s why we offer care providers free continuing medical education (CME) sessions to learn best practices to overcoming barriers in achieving clinical quality goals and improved patient outcomes.

Engagement Hub objectives:

• Learn strategies to help you and your care team improve your performance across a range of clinical areas.
• Apply the knowledge you gain from the webinars to improve your organization’s clinical quality.
• Offer care providers a convenient way to earn CME credits at a time that works best for you.

Register here for our free CME clinical quality webinars!                   

Note: Sessions in this series are approved for one American Academy of Family Physicians credit each.

Join this CME webinar to learn best practices to preventing falls of your older patients. Hear from clinical experts in patient safety as they share evidence-based strategies to help you implement a fall prevention program in nursing homes.

Learning objectives:

• Learn about the impact patient falls have on overall clinical outcomes and costs
• Arm you with strategies to successfully implement a fall prevention program in nursing homes
• Learn how to engage patients and families in fall prevention processes

Presenters:

1. Patricia Dykes, PhD, RN, FAAN, FACMI
   Center of Patient Safety, Research, and Practice
2. Udoka Okpalauwaekwe MBBS, MPH PhD
   University of Saskatchewan 

This session is approved for one AAFP credit. 

*It’s recommended to open registration link in Google Chrome browser for best experience.

Anthem Blue Cross updates the California Provider Manual annually so that our care provider partners have the current information they need to work with us. The provider manual serves as a reference document and is reviewed internally each year to reflect changes to our processes and policies.

The provider manual incorporates information for both professional and hospital/facility providers. The next update will be available on the website on April 1, 2023, and will become effective on July 1, 2023.

To view the updated manual, please visit website. Select Providers, then Policies, Guidelines & Manuals. Select your state, scroll to Provider Manual, and select Download the Manual to view and/or download the provider manual as well as BlueCard and Medicare Advantage manuals.

Archived copies of the professional and hospital/facility manual will remain available at the same location.

Keeping you informed:

• Each year, we communicate the Anthem Blue Cross (Anthem) Timely Access Regulations and Language Assistance Program to our commercial medical and behavioral health networks via an annual provider mailing. The 2023 mailing was completed in January.
• Effective July 1, 2022, Anthem implemented SB 221 – Timely Access Requirements for Non-Physician Mental Health/Substance Use Disorder Appointments. See the access standards charts on the pages that follow for more information.
• Effective January 1, 2023, SB 221 – A referral to a specialist by a primary care provider or another specialist shall be subject to the relevant time-elapsed standard.

Why is this important?

These are California state regulations.
Blue Cross of California dba Anthem Blue Cross and Anthem Blue Cross Life & Health Insurance Company (collectively, Anthem) is committed to keeping you, our network partners, updated on our activities related to our compliance with the Department of Managed Health Care (DMHC) and the California Department of Insurance (CDI) Timely Access to Non-Emergency Health Care Services Regulations (the Timely Access Regulations), respectively.

To ensure compliance with these timely access regulations, three surveys are conducted annually. The surveys include, but are not limited to the following:

• Provider Appointment Availability Survey 
• Provider Satisfaction Survey 
• Provider After – Hours Survey 

In 2023, the annual surveys will begin in July or August and will continue through December 31.

Beginning with the 2023 Provider Appointment Availability Survey (PAAS), the DMHC expanded the types of specialist physicians who are included in the PAAS. Below is a complete list of provider types and specialties who will be included in the PAAS.

Each year, we communicate Anthem’s Timely Access Regulations and Language Assistance Program to our commercial medical and behavioral health networks. The 2023 notice was mailed in January. This information also includes access to non-emergency healthcare services within prescribed timeframes (also referred to as the time-elapsed standards or appointment wait times). We appreciate that in certain circumstances time-elapsed requirements may not be met. The Timely Access Regulations have provided exceptions to the time-elapsed standards to address these situations:

• Extending appointment wait time: The applicable waiting time for a particular appointment may be extended if the referring or treating licensed healthcare provider, or the health professional providing triage or screening services, as applicable, acting within the scope of their practice and consistent with professionally recognized standards of practice, has determined and noted in the relevant record that a longer waiting time will not have a detrimental impact on the health of the patient.
• Preventive care services and periodic follow-up care: Preventive care services and periodic follow up care are not subject to the appointment availability standards. These services may be scheduled in advance consistent with professionally recognized standards of practice as determined by the treating licensed healthcare provider acting within the scope of their practice. Periodic follow-up care includes but is not limited to, standing referrals to specialists for chronic conditions, periodic office visits to monitor and treat pregnancy, cardiac or mental health conditions, and laboratory and radiological monitoring for recurrence of disease.
• Advanced access: The primary care appointment availability standard may be met if the primary care physician office provides advanced access. Advanced access means offering an appointment to a patient with a primary care physician (or nurse practitioner or physician’s assistant) within the same or next business day from the time an appointment is requested (or a later date if the patient prefers not to accept the appointment offered within the same or next business day). Note: This exception does not apply to commercial behavioral health.

24/7 NurseLine gives peace of mind
Anthem members have access to our 24/7 NurseLine — a convenient way to ask questions or get advice from a registered nurse anytime. Locate the toll-free phone number on the back of the member ID card and the wait time is not to exceed 30 minutes.

Help is a phone call away
Members and providers have access to Anthem’s Member Services team for general questions or when having difficulty obtaining a referral to a provider. Call the toll-free phone number listed on the back of the member ID card for assistance. A representative may be reached within 10 minutes during normal business hours.

For patients (members) with DMHC regulated health plans
If you or your patients are unable to obtain a timely referral to an appropriate provider or for more information about the regulations, visit the DMHC website at www.dmhc.ca.gov or call toll-free 888-466-2219 for assistance.

For patients (members) with CDI regulated health plans
If you or your patients are unable to obtain a timely referral to an appropriate provider or for more information about the regulations, visit the CDI website at www.insurance.ca.gov or call toll-free 800-927-4357 for assistance.

Language assistance program
For members whose primary language is not English, Anthem offers, at no cost, language assistance services through interpreters and other written languages. If you or the member is interested in these services, please call Anthem’s Member Services number on the member’s ID card for help (TTY/TDD: 711).

We hope this clarifies Anthem’s expectations and your obligations regarding compliance with the Timely Access Regulations. Our goal is to work with you to successfully meet the expectations for the requirements with the least amount of difficulty and member abrasion. Anthem can only achieve this compliance with the help of our network providers, you!

Take a moment to review and share the following appointment wait times with your staff and the Access Standards tables for Medical Professionals and Behavioral Health that follow. The clock starts when the request for the appointment is made.

Access Standards for medical professionals

Access Standards for Behavioral Health and Employee Assistance Program (EAP) providers

* The DMHC timely access standard is 15 business days for psychiatrists; however, to comply with the NCQA accreditation standard of 10 business days, Anthem uses the more stringent standard.

Access Standards for after hours

• Note: The next available appointment date and time can be either in person or by telehealth services.
• Only appropriately qualified staff, a physician, physician assistant, nurse practitioner, or registered nurse are allowed to provide triage or screening clinical advice.
• Interpreter services are coordinated by Anthem or its delegated network provider or other delegated entity with scheduled appointments for healthcare services in a manner that ensures the provision of interpreter services at the time of the appointment without imposing delay on the scheduling of the appointment. Anthem requires providers and provider office staff to document members’ request, acceptance, or refusal of interpreter services in the medical record.
• Referrals to specialists: A referral to a specialist by a primary care provider or another specialist shall be subject to the relevant time access standards.

Questions
If you have any questions about this communication, contact your assigned Provider Relationship Management representative or visit anthem.com/ca/provider/contact-us to view additional contact information.

Please review your online provider directory information on a regular basis to ensure it is correct. Access your online provider directory information by visiting anthem.com/ca/provider, then under Provider Overview, select Find Care.

Submit 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
• Provider leaving a group or a single location
• Phone/fax number changes
• Closing a practice location

Once you submit the form, we will send you an email acknowledging receipt of your request.

The Consolidated Appropriations Act (CAA) implemented in 2021 contains a provision that requires online provider directory information be reviewed and updated as needed at least every 90 days. By reviewing your information regularly, you help us ensure your online provider directory information is current.

At Anthem Blue Cross (Anthem) we value you as a provider in our network. That’s why we’ve redesigned one of the ways we share important information about our tools and resources to make it more useful for you.

Provider Pathways is a 24/7 digital resource that gives a foundation on doing business with Anthem. We are always looking to improve our training methodology, and this self-paced offering provides Anthem with a new approach to an easy on demand option for sharing information on our most frequently used provider tools and resources. In addition, Provider Pathways – Doing business with Anthem eLearning gives you the flexibility for scheduling training for yourself and your staff. 

You’re in control of your training experience!
You select the training path you need. Do you want to learn more about authorizations or maybe you need information on claims? You pick the path. You decide the pace. 

Provider Pathways includes information on most of our frequently used provider tools and resources, such as:

• Joining our network.
• Signing up for Availity Essentials:*
• Enrolling in EFTs/ERAs.
• Checking member eligibility and claim status.
• Authorizations and so much more.

For your convenience, Provider Pathways is available on the Provider Training Academy of the provider website at https://providers.anthem.com/ca. If you have questions about this new provider resource, please reach out to your Provider Relations team. 

A decision-making tool for patients navigating the Medi-Cal Managed Care (Medi-Cal) renewal process.
During the COVID-19 public health emergency, nearly all Medi-Cal and Children’s Health Insurance Program (CHIP) members were able to stay enrolled in their current health coverage regardless of changes in eligibility or status. As Medi-Cal renewal starts again, your patients will have to take additional steps to keep their current coverage or find a new health plan. Many will be doing this for the first time and may need advice and support to feel confident throughout the process. 

The need for reliable direction in this changing landscape
If your patients who have a Medi-Cal or CHIP plan don’t renew their benefits, or if they no longer qualify, they are at risk of losing their health coverage and the ability to stay with their current doctors and healthcare providers. 

To help your patients stay covered and remain in your care, Anthem Blue Cross developed a benefits eligibility tool that helps those enrolled in Medi-Cal or CHIP check if they qualify to renew their coverage. If they no longer qualify, it directs them to coverage and benefits information.

How the decision-making tool works
Patients can visit www.myhealthbenefitfinder.com/anthem. After they fill out information such as their age, ZIP code, annual household income, and number of household members, they select Results. The next page is customized based on their responses:

• Patients who may still qualify for Medi-Cal or CHIP health benefits are directed to their state agency website to verify their eligibility.
• Patients who no longer qualify for Medi-Cal or CHIP are directed to ‑other health plan options.

The tool also provides information on additional benefits they may qualify for, such as programs that help with food, housing, and transportation costs.

We encourage you to share the www.myhealthbenefitfinder.com/anthem website with those impacted by Medi-Cal renewal. The tool offers reassurance for those who continue to qualify for coverage, and for those who no longer qualify, guidance on other health coverage, including a Health Insurance Marketplace plan, Medicare, or employer-sponsored coverage.

Additional resources to guide your patients
To support your patients through the Medi-Cal renewal process, we’ve developed two additional resources you can share with them:

• A patient-facing sheet — https://bit.ly/3L0rROi
• An educational Medi-Cal renewal destination — anthem.com/staycovered

You and your staff can also support your patients by using the Availity Essentials* platform at Availity.com to identify your Medi-Cal and CHIP patients. For a step-by-step video tutorial that walks you through how to find this information, visit https://bcove.video/3n5Pz2a. 

You and your patients can count on us for support
Your patients may have questions about the Medi-Cal renewal process. We want you to feel confident you have the answers and resources to guide them.

Together, we can ease your patients’ potential concerns and help make sure there are no gaps in coverage or care.

If you would like more information, contact your Provider Relationship Management representative, or call the number on the back of the member’s ID card.

California providers using eConsult vendor AristaMD* no longer need to pay for eConsults conducted for Anthem patients on Medicare Advantage or Commercial health plans.

Effective February 1, 2023, Anthem will pay AristaMD on behalf of providers for eConsults for Commercial and Medicare Advantage members. Medicaid members with Anthem were already covered for eConsult services.

Electronic physician consults, or eConsults, are a way for primary care providers to request medical specialists’ assistance prior to referring a patient for in-person specialty care. Using eConsults can expand access to specialty expertise while minimizing unnecessary in-person specialist visits and wait time to see a specialist in person.

AristaMD is one of several vendors offering a specialist network and platform for transmitting and billing eConsults. They are an independent company providing services for Anthem network providers and their patients along with other health plans.

To learn more about eConsults and AristaMD, visit their website at aristamd.com.

Once you apply to join the Medi-Cal Managed Care (Medi-Cal) network — or submit a request to add a provider to your existing Medi-Cal group contract — the Availity Essentials* platform can provide an application status every step of the review process.

If you have not already done so, submit your application to enroll with the Department of Health Care Services Provider Portal (PAVE) at https://pave.dhcs.ca.gov/sso/login.do prior to applying with Anthem Blue Cross (Anthem). It is important that you have enrolled, or are in the process of enrolling, with DHCS before the next steps. Once you have enrolled, there are two easy steps to find out the status of your request:

• Sign into Availity Essentials to view My Dashboard at the top of the screen. This is where you will track your submission.
• Availity Essentials assigns an application ID once you apply or submit a request via the Digital Enrollment Process. You will need this ID to check the status of your application.

If you have questions outside of the application/request status, please use the following contacts:

• For new solo provider, new physician group, or adding to your existing Medi-Cal group, email: CAPhysicianApp@anthem.com.
• For new behavioral health or applied behavior analysis with Medi-Cal solo or group, email: bhmedi-calcontracting@anthem.com.
• For new Medi-Cal physician solo or group, email: SSB_Contract_Requests@anthem.com. 

Vaccination remains the number one defense against serious illness from COVID-19, and research tells us that recommendations from care providers is a critical factor in a patient’s decision to get vaccinated.

To support certain immunocompromised adults and pediatric individuals (12 years of age and older weighing at least 40 kg) who may not mount an adequate immune response we have updated our provider website with information on available therapeutics for COVID-19 (COVID-19 updates | Anthem Blue Cross in California). There is currently one treatment available for pre-exposure prophylaxis for COVID-19 (Evusheld), and several medications that are available for treatment of COVID-19. The currently available pre-exposure prophylaxis for COVID-19 is Evusheld (tixagevimab co-packaged with cilgavimab).

More information about Evusheld and the medical conditions and/or medications that allow an individual to qualify for Evusheld can be found on the Anthem provider website. If you would like Anthem to provide a list of your patients who are Medi-Cal members who might qualify for Evusheld, contact us at allison.lam@anthem.com.

Moving Toward Equity in Asthma Care
Anthem Blue Cross is committed to achieving health equity in asthma outcomes with diverse populations. As part of this commitment, we offer an online training, Moving Toward Equity in Asthma Care. This course is accessible from any mobile device or computer and provides one continuing medical education credit at no cost to you. Visit www.mydiversepatients.com. 

Asthma Medication Ratio (AMR) HEDIS^® measure 
The National Committee for Quality Assurance (NCQA) is also working to identify and reduce disparities in care. As part of this effort, race and ethnicity stratifications were added to the AMR HEDIS metric this year. The AMR metric measures the percentage of members 5 to 64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.5 or greater during the measurement year. 

Did you know: 

• Hispanics and African Americans with asthma are less likely to take daily controllers and are more likely to visit the ER and be hospitalized for asthma-related conditions than non-Hispanic whites? ¹
• Asian Americans are more likely to die from asthma than non-Hispanic whites?²
• Appropriate medication management for patients with asthma could reduce the need for rescue medication — as well as the costs associated with ER visits, inpatient admissions, and missed days of work or school?

Helpful tips: 

• Ensure at least half of the medications dispensed to treat asthma are controller medications throughout the measurement period. 
• Talk to the patient about the importance of controller medication compliance, and not to use rescue medications on a regular basis, unless part of asthma action plan.
• Encourage patients to fill their prescriptions on a regular schedule rather than waiting till they are symptomatic.
• Create a written asthma action plan in language the patient understands, and schedule follow-up appointments with patients. Ask patients questions to assess asthma control, adherence to the action plan, and identify
• Utilize evidence-based asthma assessment tools to assess asthma control, adherence to the action plan, and identify triggers.
• Take the Moving Toward Equity in Asthma Care CME course at no cost for more helpful tips.

Additional resources
Also available is the Asthma & Me training. Do your patients have asthma? Show them the pathophysiology of asthma in their preferred language.

References:

1. Asthma and Allergy Foundation of America & National Pharmaceutical Council. (2005). Ethnic Disparities in the Burden and Treatment of Asthma. Retrieved from http://www.aafa.org/media/Ethnic-Disparities-Burden-Treatment-Asthma-Report.pdf
2. U.S. Department of Health & Human Service, Office of Minority Health. (2016, May 9). Asthma and Asian Americans. Retrieved August 8, 2016, from https://www.minorityhealth.hhs.gov
3. Asthma and Allergy Foundation of America. (2020). Asthma Disparities in America: A Roadmap to Reducing Burden on Racial and Ethnic Minorities. Retrieved from: https://aafa.org/wp-content/uploads/2022/08/asthma-disparities-in-america-burden-on-racial-ethnic-minorities.pdf

CABC-CD-019256-23-CPN18979

Please continue to check for important Medi-Cal Managed Care updates, including:

• New specialty pharmacy medical step therapy requirements
• Clinical Criteria updates
• Prior authorization requirement changes effective August 1, 2023
• New specialty pharmacy medical step therapy requirements (Alymsys)
• New specialty pharmacy medical step therapy requirements (Zarxio, Granix, Neupogen, Nivestym, Releuko)

The fax number on the previous communication was incorrect and has been corrected here. The correct fax number is 833-678-0223.

For services beginning on July 1, 2023, prior authorization requests for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services will be reviewed by Carelon Post Acute Solutions, LLC.* The goal of this program is to ensure members receive the right product for the right duration of time in the home. This change will be applicable to the following markets: California.

How to submit or check a prior authorization request
For DMEPOS services, Carelon Post Acute Solutions will begin receiving requests on Tuesday, June 20, 2023, for dates of service July 1, 2023, and after.  

Providers are encouraged to request authorization using the website. Go here to get started. You can upload clinical information and check the status of your requests through this online tool seven days a week, 24 hours a day. If you are unable to use the link or website, you can call the Carelon Post Acute Solutions Provider Call Center at 844-411-9622 during normal operating hours from 7 a.m. to 7 p.m. CT, Monday through Friday, or send a fax to Carelon Post Acute Solutions at 833-678-0223.

Please note: Carelon Post Acute Solutions will not review authorization requests for products/services that do not fall under Medicare-covered products/services, such as home infusion, hospice, outpatient therapy, or supplemental benefits that help with everyday health and living such as personal home helper services offered under Essential/Everyday Extras.

To learn more about Carelon Post Acute Solutions and upcoming training webinars, visit the website or email.

If you have additional questions, please call the Carelon Post-Acute Solutions Provider Call Center at 844-411-9622.

Who is affected
For women ages 67 to 85 who sustained a recent fracture, it is important to obtain a bone density scan to assess for osteoporosis. 

How can we collaborate?
We can help your patients complete this scan in the comfort of their home through Quest Health Connect.

In home resources
We are working with Quest HealthConnect™*, a Quest Diagnostics service, to provide this service at no added cost to you. Quest HealthConnect will call your patient to arrange a visit. Patients may also call them directly at 888-306-0615 between 8:30 a.m. to 4 p.m. Eastern Time. The result(s) of the screening test(s) will be sent to both the patient and your office after the visit.

Please continue to check for important Medicare Advantage updates, including:

• Medical Policies and Clinical Utilization Management Guidelines update
• Itemized bill review program