In an effort to better service our contracted providers right the first time, Anthem Blue Cross has improved our provider claim escalation process. Just click, Provider Claim Escalation Process to read, print, download and share the improved process with your office staff.

Our Network Relations Team is available by email at CAContractSupport@anthem.com to answer questions you have about the process.

Exciting new changes are on the horizon for the public provider site at www.anthem.com/ca. These next wave of updates include:

• A new Contact Us page that gives providers easy access to important contact information
• A redesigned Medicare Advantage page with an improved, effortless user experience
• A new Enhanced Personal Health Care (EPHC) page that provides a more prominent and easier access to information that communicates  Anthem Blue Cross' role in transforming health care. (EPHC is a program designed to advance and support a patient-centered approach to care delivery.)

Preview of the new Contact Us and Medicare Advantage page.

EPO Plans and Network

For the 2020 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, and 10. 

We are also very pleased to announce the expansion of our Individual EPO on and off exchange plans into rating regions 9 and 12.  Below is a list of counties located in those regions where Anthem will be offering 2020 EPO on and off exchange Individual plans.

Providers in Regions 1, 7 and 10

If you are participating in the 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  

• The 2020 EPO plans do not have out-of-network benefits except for emergent/urgent or authorized services only.

Providers in Region 9 and 12

If you participated in the on- and off- exchange network in 2017, we have reinstated your participation in the Individual EPO exchange network under your Anthem provider agreement.  We have further extended participation to several providers who previously did not participate in the Anthem Individual EPO exchange.  A communication has been sent to both previously participating providers and new providers in the EPO Individual exchange.

• The 2020 EPO plans do not have out-of-network benefits except for emergent/urgent or authorized services only.

HMO Plans and Network

Starting with 2020 benefit year, Anthem Blue Cross (Anthem) is excited to re-enter rating regions 11, 15, 16 and 17 with our HMO Individual on exchange and off exchange plans.  The Anthem HMO network in these regions is considered a “narrow” network and providers have been selected and agreements executed.  Below is a list of counties located in the regions where Anthem will be offering 2020 Individual on and off exchange HMO plans.

These changes do not impact Anthem CA Individual “grandfathered” business. 

Anthem appreciates your partnership and continued participation in our Individual on and off exchange networks.  If you have any questions regarding this information please contact Anthem’s Network Relations department via email at CAContractSupport@Anthem.com.

The National Accounts 2020 Pre-certification list has been published. Please note, providers should continue to verify member eligibility and benefits prior to rendering services.

Continuing our 2019 CRA updates, Anthem Blue Cross (Anthem) requests your assistance with respect to accurately reporting our member’s health status to CMS.

2019 Retrospective Chart Request

Retrospective medical chart collection begins in November and it is the most significant and largest volume of our requests.  We appreciate your collaboration as we work through the requests and submit to your medical records department in a timely manner.

Electronic options for chart collections

We have 4 electronic options for chart collections to choose from:  1.)  Remote/Direct Anthem Access;  2.)  Electronic Medical Record (EMR) Interoperability with 4 EMR systems;  3.) Inovalon virtual visit or onsite;  4.) Secure FTP.  Submitting medical charts can be time consuming for your staff.  Utilizing an electronic option can alleviate the constraints on your staff’s resources and time. 

The most efficient electronic option is to allow the Anthem medical coder team to have direct connection access to your EMR system (Option 1), so that we may retrieve the records ourselves.  Our team has collaborated with several Providers and Facilities to have direct access to their EMR systems to collect the charts.  This allows for no vendor interventions and fewer handoffs of the records.  To address compliance concerns, please note that as a health plan, Anthem is a covered entity under the HIPAA Privacy Rule and is bound to protect PHI. 

If you are interested in any of these electronic options, or you would like to grant Anthem medical coders direct access to your EMR system, please contact our Commercial Risk Adjustment Representative who supports your area: Socorro.Carrasco@anthem.com.

Thank you for your continued efforts with our CRA Program, and your help in expediting chart collection requests.

As we continue our efforts to help ensure our members enrolled in Affordable Care Act (ACA) compliant plans have their chronic conditions assessed and documented each year, Anthem Blue Cross (Anthem) is engaging Matrix to help encourage members – on our behalf – to schedule a mobile health clinic assessment.  A vendor, Matrix operates the largest fleet of mobile medical centers nationwide and has conducted more than 1,000,000 patient assessments since 1998 – providing convenient access to comprehensive health assessments. 

The mobile clinic provides members with additional options to help them close any gaps in care that they may have.  In late July, Matrix began reaching out to members on our behalf by letter and phone. Our outreach efforts will continue until the end of this year.

Matrix works with hospitals and health plans like Anthem to deliver preventive health testing to the communities Matrix serves.  Each mobile clinic has a reception area and private screening rooms.  Matrix also helps members with scheduling follow-up appointments with their PCPs at the end of the assessments and forwards the PCPs a copy of any results from the health assessment.

Matrix In-Home Assessments

Matrix will perform in-home assessments where possible. The in-home assessments offer a board-certified nurse practitioner (NP) to come to a member’s home to provide a general exam, suggestions for important screenings or other tests, a full review of the medicines they take, answers to health-related questions & a personal health summary detailing their health information.   A copy of the assessment will be sent to members’ PCPs to ensure continuity of care.

The overall goals of the mobile clinic program and the in-home program are to provide convenient, comprehensive appointments that are designed to complement the care provided by our network of physicians.  These mobile clinic or in-home visits do not replace any active treatment plans members currently have with their physicians and are not considered wellness visits or a substitute for members’ annual physical examinations. 

We’re including information about the program in this edition of Provider News should patients contact you about the program.  Please refer members directly to Matrix if they have questions or need more information:

Mobile Bus: 1-888-822-3247

In-Home: 1-855-403-0967

As a Participating Provider with the Anthem Blue Cross Workers’ Compensation Network you have agreed to treat injured workers and accept reimbursement from “Other Payors” per your Provider Agreement.  To access the listing of Other Payors in our Network Leasing Arrangement publication, go online to:

Availity.com > Log into Availity > Payer Spaces > Anthem Blue Cross > Education and Reference Center > Administrative Support > Network Leasing Arrangements”.

The Other Payor listing is updated monthly. All Other Payors listed have signed an agreement with Anthem Blue Cross Workers’ Compensation to access the workers’ compensation network.

Farmers Insurance and its affiliates will be listed as an Other Payor for workers’ compensation effective October 1st 2019 in the Anthem Workers’ Compensation section of our Network Leasing Arrangement publication. Farmers Insurance will make the entire Anthem Blue Cross Workers’ Compensation Network available to injured workers participating in the Anthem Premier Plus Medical Provider Network (MPN) , to the extent the injured worker is approved to treat with a participating provider outside of the Anthem Premier Plus MPN.  Therefore, in the near future you may see a difference in reimbursement to certain bills that have been repriced to your Anthem Blue Cross contract rate.

If you have any questions regarding your reimbursement rates, please contact Anthem Blue Cross Workers’ Compensation Customer Relations at:  1-866-700-2168

Blue Cross of California dba Anthem Blue Cross and Anthem Blue Cross Life & Health Insurance Company (collectively, Anthem”) are 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. Anthem maintains policies, procedures, and systems necessary to ensure compliance with the Timely Access Regulations, including access to non-emergency health care services within prescribed timeframes (also referred to as the “time elapsed standards” or “appointment wait times”). Anthem can only achieve this compliance with the help of our provider network partners, you! 

There are many activities that are conducted to support compliance with the regulations and we need you, as well as covered individuals, to help us attain the information that is needed. These studies allow our Plan to determine compliance with the regulations.

The activities include, but are not limited to the following:

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

These surveys are currently in process; please review this information with your office staff so they are prepared and understand the importance of each provider’s participation in each of the surveys.

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 health care provider, or the health professional providing triage or screening services, as applicable, acting within the scope of his or her 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 health care provider acting within the scope of his or her 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).

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

To view the table of standards select the attachment.

Members also have access to Anthem’s 24/7 NurseLine. The NurseLine wait time is not to exceed 30 minutes. The phone number is located on the back of the member ID card. In addition, Members and Providers have access to Anthem’s Customer Service team at the telephone number listed on the back of the member ID card. A representative may be reached within 10 minutes during normal business hours.

Please contact the Anthem Member Services team at the telephone number listed on the back of the member ID card to obtain assistance if a patient is unable to obtain a timely referral to an appropriate provider.

If you have further questions, please contact Network Relations at CAContractSupport@anthem.com.

For Patients (Members) with Department of Managed Health Care Regulated Health plans:

If you or your patients are unable to obtain a timely referral to an appropriate provider or for additional information about the regulations, visit the Department of Managed Health Care’s website at www.dmhc.ca.gov/HealthCareinCalifornia/YourHealthCareRights/TimelyAccesstoCare.aspx or call toll-free 1-888-466-2219 for assistance.

For Patients (Members) with California Department of Insurance Regulated Health plans:

If you or your patients are unable to obtain a timely referral to an appropriate provider or for additional information about the regulations, visit the Department of Insurance’s website at www.insurance.ca.gov or call toll-free 1-800-927-4357 for assistance.

Language Assistance Program

For members whose primary language isn’t English, Anthem offers free language assistance services through interpreters and other written languages. If you or the member is interested in these services, please call the Anthem Member Services number on the member’s ID card for help (TTY/TDD: 711).

This is a one week observance that gives organizations and providers an opportunity to raise awareness on the appropriate use of antibiotics and reduce the threat of antibiotic resistance. The Centers for Disease Control and Prevention (CDC) has many tools for providers at https://www.cdc.gov/antibiotic-use/week/toolkit.html.  Posters, prescriptions pads, social media posts, patient education pieces, sticker and counter clings, and more can be found on the CDC website.

During U.S. Antibiotic Awareness Week and throughout the year, the CDC promotes Be Antibiotics Aware, an educational effort to raise awareness about the importance of safe antibiotic prescribing and use. Be Antibiotics Aware has resources to help healthcare professionals (in outpatient and inpatient settings) educate patients and families about antibiotic use and risks for potential side effects. For more information visit: https://www.cdc.gov/antibiotic-use/?s_cid=NCEZID-AntibioticUse-005.

Our Provider Network Education team offers quality complimentary educational programs and materials specially designed for our providers. For a complete listing of our workshops, seminars, webinars and job aids, log on to the Anthem Blue Cross website: www.anthem..com/ca.

Scroll down the page to Partners in Health > Tools for Providers. In the middle of the page select the box

Find Resources for California. From the Answers@Anthem page, select the link titled Provider Education Seminars and Webinars link.

It is extremely important that we have accurate and up-to-date information about your practice in our directories. Senate Bill 137 (SB 137), requires that Anthem Blue Cross (Anthem) provide our members accurate and up-to-date provider directory data. As a result, Anthem will be conducting ongoing outreaches to all practices to confirm the information we have on file is accurate. Without verification from you that our Provider Directory information is accurate, we will be required to remove your practice from the directories we make available to our members. We appreciate your attention to this matter.

Anthem 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.

Connecting with Anthem Blue Cross and staying informed will be even easier, faster and more convenient than ever before with our Provider News publication.

Provider News is our web tool for sharing vital information with you. It features short topic summaries and links that let you dig deeper into timely critical business information:

• Important website updates
• System changes
• Fee Schedules
• Medical policy updates
• Claims and billing updates

……and much more                                                                                                                          Registration is fast and easy. There is no limit to the number of subscribers who can register for Provider News, so you can submit as many e-mail addresses as you like.

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.

Policy Update

Child Health and Disability Program (CHDP)

(Effective 11/30/19)

Currently, the following component services are separately reimbursable from the preventive medicine evaluation and management (E&M) visit by Anthem Blue Cross (Anthem). However, effective November 30, 2019, Anthem will no longer reimburse the following services separately from the preventive medicine E&M visit:

• Audiometry screening
• Visual equivalent test

For additional information, please review the Child Health and Disability Program (CHDP) reimbursement policy at https://mediproviders.anthem.com/ca.

Click here for additional information about the March 2019 Medical Policies and Clinical Utilization Management Guidelines update.

To view all the updates select the Medical Policies and Clinical Utilization Guidelines attachment.

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The Medicare Risk Adjustment Regulatory Compliance team at Anthem Blue Cross offers two provider training programs regarding Medicare risk adjustment guidelines. Information for each training is outlined below. The Medicare Risk Adjustment Regulatory Compliance team developed the following two provider trainings. This update outlines the training series:

Medicare risk adjustment and documentation guidance (general)

When — offered the first Wednesday of each month from December 5, 2018, to November 6, 2019 at 1 to 2 p.m. Eastern time

Learning objective — this training will provide an overview of Medicare Risk Adjustment, including the Risk Adjustment Factor and the Hierarchical Condition Category (HCC) Model, with guidance on medical record documentation and coding.

Credit —  this activity has been reviewed and is acceptable for up to one prescribed credit by the American Academy of Family Physicians.

If you are interested in joining us to learn how providers play a critical role in facilitating the risk adjustment process, register for one of the monthly training sessions at the link below:

https://antheminc.adobeconnect.com/admin/show-event-catalog?folder-id=38826374.

Medicare risk adjustment, documentation and coding guidance

(condition specific)

When — offered on the fourth Wednesday of every other month from January 23, 2019 to November 27, 2019 from noon to 1 p.m. Eastern time

Learning objective — this is a collaborative learning event with Enhanced Personal Health Care (EPHC) to provide in-depth disease information pertaining to specific conditions including an overview of their corresponding hierarchical condition categories (HCC), with guidance on documentation and coding.

Credit — this live series activity has been reviewed and is acceptable for credit by the American Academy of Family Physicians.

For those interested in joining us for this six-part training series, please see the list of topics and scheduled training dates below:

1. Red flag HCCs, part one — Register for recording of live session.

Training will cover HCCs most commonly reported in error as identified by CMS: chronic kidney disease (stage 5), ischemic or unspecified stroke, cerebral hemorrhage, aspiration and specified bacterial pneumonias, unstable angina and other acute ischemic heart disease, and end-stage liver disease. Recording will play upon registration.

https://antheminc.cosocloud.com/e4i5k4h7cf3j/event/registration.html.

1. Red Flag HCCs, part two — Register for recording of live session.

Training will cover HCCs most commonly reported in error as identified by CMS: atherosclerosis of the extremities with ulceration or gangrene, myasthenia gravis/myoneural disorders and Guillain-Barre syndrome, drug/alcohol psychosis, lung and other severe cancers, and diabetes with ophthalmologic or unspecified manifestation. Recording will play upon registration.

https://antheminc.cosocloud.com/enfndbyedd5g/event/event_info.html.

1. Opioids and more: substance abuse and dependence — Recording will play upon registration. https://antheminc.cosocloud.com/ekx3tooh22f7/event/registration.html.

1. Acute, chronic and status conditions — Recording will play upon registration.

https://antheminc.cosocloud.com/eeq7am1fht49/event/registration.html.

1. Diabetes mellitus and other metabolic disorders — September 25, 2019 https://antheminc.cosocloud.com/e9l4sxzbd2lq/event/registration.html.

1. Behavioral health — November 27, 2019 https://antheminc.cosocloud.com/eatxsocnqf6h/event/registration.html.

On January 1, 2020, Anthem Blue Cross (Anthem) will implement a preferred edit on Medicare-eligible continuous glucose monitors (CGMs). Currently, there are two CGM systems covered by CMS under the Medicare Advantage Part D (MAPD) benefit; these are Dexcom and Freestyle Libre. The preferred CGM for Medicare Advantage Part D individual members covered by Anthem will be Freestyle Libre. This edit will only affect members who are newly receiving a CGM system. Members will need to obtain their CGM system from a retail or mail order pharmacy – not a durable medical equipment (DME) facility. For Dexcom coverage requests, call 1-833-293-0661.

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Click here for additional information about Lowering health risks with no-cost statins.

On February 22, 2019, and March 14, 2019, the Pharmacy and Therapeutics (P&T) Committee approved changes to Clinical Criteria applicable to the medical drug benefit for Anthem Blue Cross. These policies were developed, revised or reviewed to support clinical coding edits.

The Clinical Criteria is publicly available on the provider website, and the effective dates will be reflected in the Clinical Criteria Q1 web posting. Visit Clinical Criteria to search for specific policies.

For questions or additional information, use this email.

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Click here for additional information about Assisting your patients in managing the Donut Hole.

Click here for additional information about the Prior authorization requirements for continuous positive airway pressure supplies.

The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. For markets with carved-out pharmacy services, the applicable listings below are informational only.

Please share this notice with other members of your practice and office staff.

To view a guideline, visit https://www11.anthem.com/ca_search.html.

• Notes/updates:

Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive.

• *DME.00037 — Added devices that combine cooling and vibration to the Investigational (INV) & not medically necessary (NMN) statement
• *LAB.00027 — Added Mediator Release Test to INV&NMN statement
• *LAB.00033 — Clarified INV&NMN statement to include 4Kscore and AR-V7
• *OR-PR.00003:
  • Clarified medically necessary (MN) position statement criteria 2 to 4
  • Added statement that use of prosthetic devices that combine both a microprocessor controlled knee and foot-ankle prosthesis is considered INV&NMN for all indications
• *SURG.00011:
  • Added new MN and INV&NMN statements addressing amniotic membrane‑derived products for conjunctival and corneal indications, including KeraSys and Prokera
  • Added new products to INV&NMN statement
• *SURG.00045:
  • Added erectile dysfunction, Peyronie’s disease and wound repair to the INV&NMN statement
  • Revised title
• *SURG.00121 — Added INV&NMN statement to address use of transcatheter tricuspid valve repair or replacement for all indications
• The following AIM Specialty Health® updates were approved on June 6, 2019:
  • Advanced Imaging:
    • Imaging of the Heart
    • Oncologic Imaging
    • Vascular Imaging
  • Proton Beam Therapy
  • Rehabilitative Therapies — Physical Therapy, Occupational Therapy and Speech Therapy (New)

To view all the updates select the Medical Policies and Clinical Utilization Guidelines attachment.

Anthem Blue Cross will implement the following clinical guideline effective December 1, 2019, to support the review for unnecessary outpatient pneumatic compression devices (PCDs) postoperative orthopedic procedures.

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

CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Lower Limbs

PCDs are used in clinics or can be purchased or rented for home use for prevention and treatment of a number of conditions. PCD therapy involves the use of an inflatable garment and an electrical pneumatic pump. The garment is intermittently inflated and deflated with cycle times and pressures that vary between devices. This document only addresses the home use of PCDs postoperative outpatient orthopedic procedures for the prevention of deep vein thrombosis (DVT) of the lower limbs.

Note: This document addresses devices for the prevention of DVT only. Pneumatic devices used in the treatment or prevention of lymphedema, venous insufficiency and therapy for musculoskeletal injuries are not addressed in this document, nor are devices for prevention of DVT post major surgical procedures.

Not medically necessary

The home use of PCDs for prevention of thromboembolism of the lower limbs following outpatient orthopedic surgery is considered not medically necessary for all indications.

Click here for additional information about the Clinical Laboratory Improvement Amendments for Anthem Blue Cross.

Click here for additional information about the Regulatory updates.

Click here for additional information about the Pharmacy benefit manager change to IngenioRx.

The Medical Policies and Clinical Utilization Management (UM) Guidelines below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. For markets with carved-out pharmacy services, the applicable listings below are informational only.

Please share this notice with other members of your practice and office staff.

To view a guideline, visit https://www11.anthem.com/ca_search.html.

Notes/updates:

• CG-DME-44 — Electric Tumor Treatment Field (TTF) was revised to add the use of enhanced computer treatment planning software (such as NovoTal) as not medically necessary (NMN) in all cases.
• CG-MED-72 — Hyperthermia for Cancer Therapy was revised to clarify medically necessary (MN) and NMN statements addressing frequency of treatment.
• CG-SURG-09 — Temporomandibular Disorders was revised to clarify MN and NMN criteria and removed requirement for FDA approval of prosthetic implants.
• CG-SURG-30 — Tonsillectomy for Children with or without Adenoidectomy was revised to:
  • Spell out number of episodes of throat infections in MN criteria (A1, A2, A3).
  • Clarify criterion addressing parapharyngeal abscess (B4) to say two or more.
  • Add “asthma” as potential condition improved by tonsillectomy in MN criteria (C1b).
• The following AIM Specialty Health® updates took effect on September 28, 2019:
  • Advanced Imaging
    • Imaging of the Brain
    • Imaging of the Extremities
    • Imaging of the Spine

As we prepare for the potential regulatory-proposed standards for electronic attachments, Anthem will be implementing X12 275 electronic attachment transactions (version 5010) for claims.

Standard electronic attachments will bring value to you by eliminating the need for mailing paper records and reducing processing time overall. 

Anthem and Availity will pilot electronic data interchange batch electronic attachments with previously selected providers. Both solicited and unsolicited attachments will be included in our pilots.

Attachment types

• Solicited attachments: The provider sends a claim and the payer determines there is not enough information to process the claim. The payer will then send the provider a request for additional information (currently done via letter). The provider can then send the solicited attachment transaction, with the documentation requested, to process the claim.
• Unsolicited attachment: When the provider knows that the payer requires additional information to process the claim, the provider will then send the X12 837 claim with the Paper Work Included segment tracking number. Then, the provider will send the X12 275 attachment transaction with the additional information and include the tracking number that was sent on the claim for matching.

What you can do

As we prepare for this change, you can help now by having conversations with your clearinghouse and/or electronic healthcare records vendor to determine their ability to set up the X12 275 attachment transaction capabilities.

In addition, you should be on the lookout for additional information and details about working with Anthem and Availity to send attachments via electronic batch.

Click here for additional information about the Prior authorization requirements for Global March MPTAC CCRT Configuration.

Click here for additional information about the MCG Care Guidelines update and customizations.

Click here for additional information about the MCG Care Guidelines update and customizations.

Click here for additional information about the June 2019 Medical Policies and Clinical Utilization Management Guidelines update.

As we prepare for the potential regulatory-proposed standards for electronic attachments, Anthem Blue Cross (Anthem) will be implementing X12 275 electronic attachment transactions (version 5010) for claims.

Standard electronic attachments will bring value to you by eliminating the need for mailing paper records and reducing processing time overall. 

Anthem and Availity will pilot electronic data interchange batch electronic attachments with previously selected providers. Both solicited and unsolicited attachments will be included in our pilots.

Attachment types

• Solicited attachments: The provider sends a claim and the payer determines there is not enough information to process the claim. The payer will then send the provider a request for additional information (currently done via letter). The provider can then send the solicited attachment transaction, with the documentation requested, to process the claim.
• Unsolicited attachment: When the provider knows that the payer requires additional information to process the claim, the provider will then send the X12 837 claim with the Paper Work Included segment tracking number. Then, the provider will send the X12 275 attachment transaction with the additional information and include the tracking number that was sent on the claim for matching.

What you can do

As we prepare for this change, you can help now by having conversations with your clearinghouse and/or electronic healthcare records vendor to determine their ability to set up the X12 275 attachment transaction capabilities.

In addition, you should be on the lookout for additional information and details about working with Anthem and Availity to send attachments via electronic batch.

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As we prepare for the potential regulatory-proposed standards for electronic attachments, Anthem will be implementing X12 275 electronic attachment transactions (version 5010) for claims.

Standard electronic attachments will bring value to you by eliminating the need for mailing paper records and reducing processing time overall. 

Anthem and Availity will pilot electronic data interchange batch electronic attachments with previously selected providers. Both solicited and unsolicited attachments will be included in our pilots.

Attachment types

• Solicited attachments: The provider sends a claim and the payer determines there is not enough information to process the claim. The payer will then send the provider a request for additional information (currently done via letter). The provider can then send the solicited attachment transaction, with the documentation requested, to process the claim.
• Unsolicited attachment: When the provider knows that the payer requires additional information to process the claim, the provider will then send the X12 837 claim with the Paper Work Included segment tracking number. Then, the provider will send the X12 275 attachment transaction with the additional information and include the tracking number that was sent on the claim for matching.

What you can do

As we prepare for this change, you can help now by having conversations with your clearinghouse and/or electronic healthcare records vendor to determine their ability to set up the X12 275 attachment transaction capabilities.

In addition, you should be on the lookout for additional information and details about working with Anthem and Availity to send attachments via electronic batch.

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Click here for additional information about the Prior authorization requirements for Global March MPTAC CCRT Configuration.

The Aspire Telehealth Palliative Care program provides an additional layer of telephonic support to patients facing a serious illness. The program is focused on:

• Helping patients understand their diagnosis.
• Facilitating conversations with patients and their families around their goals of care.
• Ensuring patients receive care aligned with their goals and values.

The program begins with an initial 30 to 60 minute telephonic assessment by a specially trained Aspire Health social worker. The conversation in this initial call focuses on building rapport and completing a comprehensive assessment. This assessment includes understanding the patient's perception of their illness and current treatment plan. Follow-up calls occur every 2 to 4 weeks, typically lasting 15 to 45 minutes, with the exact frequency based on a patient's individual need. Aspire Health's social workers are supported by a full interdisciplinary team of board-certified palliative care physicians, nurses, and chaplains who provide additional telephonic support to patients and their families as needed. Patients enrolled in the telehealth program have access to 24/7 on-call support. The average patient is enrolled in the program for 6 to 8 months with some of the key goals being the ability for patients to teach-back their current medical situation, articulate their health and quality-of-life goals, and establish a future care plan through either the completion of advanced care planning documents and/or a transition to hospice when appropriate.

More information is available at www.aspirehealthcare.com or by calling the 24/7 Patient & Referral Hotline at 1-844-232-0500.

* Aspire Health is an independent company providing telephonic palliative care on behalf of Anthem Blue Cross.
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