 Provider News ColoradoAugust 2022 Anthem Provider News and Important Updates - ColoradoSubmitting your updates promptly helps ensure we have the most current online provider directory information available to members. We ask that you review your information regularly and let us know as soon as possible if any of your information we show in our online directory has changed.
If updates are needed, you can use our online Provider Maintenance Form. Using this form, you can update:
- Add/change an address location
- Name change
- Tax ID changes
- Provider leaving a group or a single location
- Phone/fax number changes
- Closing a practice location
Once you submit the Provider Maintenance Form, you will receive an email acknowledging that we received your request. See the Provider Maintenance Form for complete instructions.
The Consolidated Appropriations Act (CAA), effective January 1, 2022, contains a provision that requires online provider directory information be reviewed and updated (if needed) at least every 90 days. Help us keep our online provider directories current.
Anthem Blue Cross and Blue Shield would like to remind you of the procedures to follow for inpatient claim denials:
- If claim is billed as inpatient bill type in error, a replacement bill xx7 is a replacement of the same type of bill (ex. x11 and x17, or x31 and x37; you may not use a x37 to replace a x11 or a x17 to replace a x31).
- If you are changing the bill type from inpatient to outpatient or outpatient to inpatient, the original claim will need to be voided by using a frequency type 8 (void).
- The void request must be submitted first by the provider, or in conjunction with a frequency type 1 (original) inpatient or outpatient claim before the outpatient bill type claim will be processed.
- This can be done electronically or with a provider adjustment request (PAR) form.
- Further instructions are included in the provider manual.
It is inappropriate to re-bill an outpatient claim when receiving a denial/upheld appeal response for ancillary services rendered in the inpatient setting for commercial polices. This includes, but is not limited to, emergency department, imaging, laboratory services, specialty pharmacy, and surgeries.
Claims should be coded and billed based on the medical record and the physician order.
For complete information on electronic claims processing procedures, visit the Electronic Data Interchange (EDI) page on our website.
Note: This update does not apply to Medicaid or Medicare Advantage.
According to the American Medical Association (AMA) Current Procedural Terminology® (CPT) guidelines, a new patient is defined as one who has not received any professional services, i.e. face-to-face services from a physician/qualified healthcare professional, or another physician/qualified healthcare professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
By contrast, AMA CPT guidelines state that an established patient is one that has received professional services from the physician/qualified healthcare professional or another physician/qualified healthcare professional in the same group and of the same specialty and subspecialty within the prior three years.
Effective with claims processed on or after 30-day notice, Anthem Blue Cross and Blue Shield will add rigor to its existing review of professional provider claims for new patient evaluation and management (E/M) services submitted for the same patient within the last three years to align with the AMA CPT guidelines. Claims that do not meet these criteria will be denied.
Providers who believe their medical record documentation supports a new patient E/M service for the same patient within the last three years should follow the Claims Payment Dispute process (including submission of such documentation with the dispute) as outlined in the Provider Manual or resubmit the claim with an established patient E/M.
If you have questions on this program, contact your contract manager or Provider Experience representative.
Our Working with Anthem webinars are focused on one topic each session and designed to help our providers and their staff learn how to use the tools currently available to improve operational efficiency when working with Anthem Blue Cross and Blue Shield (Anthem).
2022 subject specific webinars
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Topic:
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Quick Tips: Adding, changing, and terming a provider using the Provider Maintenance Form (PMF)
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Date/time:
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Wednesday, August 31, 2022, from noon to 1 p.m. MT
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Description:
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Learn how to use the online PMF to submit changes such as the following:
· Change of address/location
· Name change
· Tax ID changes
· Provider leaving a group or a single location
· Change in phone/fax numbers
· Closing a practice location
· Change in status for accepting new patients
· Plus, more!
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Registration link:
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New as of May 9, 2022:
https://attend.webex.com/attend/onstage/g.php?PRID=cacb2b7aea26c3b21dbfd40d46017c97
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Webinars are offered using Cisco WebEx. There is no cost to attend. Access to the internet, an email address, and telephone are all that is needed. Attendance is limited, so please register today.
Watch for additional topics and dates in future issues of our monthly provider newsletter throughout the year.
Recorded sessions
Most sessions are recorded, and playback versions are available on our Registration Page. The top portion of the page will show Upcoming Events, and the bottom portion will show Event Recordings.
Note: Event recordings will require a password. Even if you are unable to attend, please register for the event to ensure you will be notified of the event recording and password once it is available.
Action needed
We have had a change in our registration link as of May 9, 2022. If you previously registered for any Working with Anthem webinars prior to May 9, 2022, please delete all calendar invitations as they cannot be cancelled. If you had registered for future sessions, please ensure you have deleted those invites as well. Please note they were previously scheduled through January 12, 2023. The old WebEx link URL starts with anthem.webex.com.
Once you register with the new registration link, the new WebEx link URL will start with attend.webex.com.
Anthem Blue Cross and Blue Shield appreciates the feedback you shared about the Availity Essentials* multi-payer authorization application. The insight you provided about your user experience has enabled enhancements that we hope will further improve your experience:
- Easier to track your authorization requests: Case numbers are being returned following your authorization submission, making it easier to track your authorization requests.
- Expanded procedure code options: You can now submit your procedure codes by visits and hours, in addition to days and units.
- Error code improvements: Recognizing that error codes can be difficult to understand, we have rewritten them to be more clear, concise, and actionable.
- Enhancements to the admissions dropdown menu: For outpatient submissions, an enhancement to the level of service improves turnaround time for case decision. For inpatient and outpatient submissions, urgent requests receive a confirmation message.
- Update to Add Attachment feature: We have added a reminder notification that enables you to double check that the attachments are connected to the correct member for the correct
Become an Availity Essentials user today
If you aren’t registered to use Availity Essentials, signing up is easy and 100% secure. There is no cost for our providers to register or to use any of the digital applications. Start by logging onto Availity.com and selecting the Register icon at the top of the home screen, or you can use this link to access the registration page.
Access to training for Availity Essentials can be helpful when trying to master applications like claims attachments, authorizations and eligibility and benefits. The Provider Learning Hub on Anthem.com is not only a new way to access training, it also offers a new learning experience.
Short, easy to follow training videos with supporting resources are available on the Provider Learning Hub – no username and password required. Access it at your convenience and share your learnings with others on your teams. Handy filtering options enable you to quickly find what you are looking for including an option to save trainings to a Favorites folder for easy access later. You will register for the Provider Learning Hub once. On future visits your preferences are populated, eliminating the need for any additional logon information.
Get started today! Access the Provider Learning Hub using this link or from Anthem.com under Important Announcements on the home page.
Digital claims attachments expedite claims processing and payment. That’s why we have been hard at work making the digital attachment process easier, more intuitive and streamlined. Now you can add attachments directly to your claim by using the new Send Attachments feature from the Claims Status application on Availity.com.
Submitting attachments electronically:
- Reduces costs associated with manual submission.
- Reduces errors associated with matching the claim when attachments are submitted manually.
- Reduces delays in payments.
- Saves time because there is no need to copy, fax, or mail.
- Reduces the exchange of unnecessary member information and personal health information.
Didn’t submit your attachment with your claim? No problem!
If you submitted your claim through EDI using the 837, and the PWK segment contains the Attachment Control Number, there are three options for submitting attachments:
1. Through the Attachments Dashboard Inbox:
- From com, select the Claims & Payments tab to access Attachments – New and your Attachments Dashboard Inbox
2. Through the 275 attachment:
- Important: You must populate the PWK segment on the 837 with your document control number to ensure the claim can match to the attachment
3. Through the Availity.com application:
- From com, select the Claims & Payments tab to access Claims Status to locate your claim. When you have found your claim, use the Send Attachments button.
If you submitted your claim through the Availity Essential Claims application:
- Simply submit your attachment with your claim
- If you need to add additional attachments, to add a forgotten attachment, or for claims adjustments:
- From Availity.com, select the Claims & Payments tab, and access Claims Status to locate your claim. When you have found your claim, use the Send Attachments button.
Learn more about the Send Attachment feature
In collaboration with Availity Essentials, we will hold a series of educational webinars that include a deep dive into EDI attachment submissions, as well as the new Claims Status workflow.
Sign up for a live webinar today:
Reductions in missed appointments are significant
Telehealth visits are having a significant impact on missed appointments according to a study published in Counseling Psychology Quarterly. Prior to transitioning to telehealth, clinicians in the study “Psychotherapy at a public hospital in the time of COVID-19: telehealth and implications for practice, i” experienced a 14.25% missed appointment rate. After transitioning to telehealth, the missed appointment rate fell to 5.63%.
Rate of missed appointments before and after transitioning to telehealth
The graph below illustrates the changes in the average rate of missed appointments (cancellations and no-show) for each of the eight clinicians in the study between the periods before and after the transition to telehealth.
https://www.tandfonline.com/doi/full/10.1080/09515070.2020.1777390
“While there are a number of limitations to consider regarding this data, [which is further discussed in the study], the statistically significant reduction in missed appointments pre-and-post [digital] transition is striking,” cited in the study report.
Telehealth and telephone visits with members after a behavioral health inpatient stay meet HEDIS criteria for the measure: Follow-up after Hospitalization for Mental Illness (FUH). With transportation being one of the barriers to after hospitalization follow-up, telehealth visits could be an ideal solution.ii
The FUH HEDIS measure evaluates:
- Members (6 years and older) who were hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner.
Two areas of importance for this HEDIS measure are:
- The percentage of behavioral health inpatient discharges for which the member received follow-up within seven days after discharge.
- The percentage of behavioral health inpatient discharges for which the member receive follow-up within 30 days after discharge.
These two consecutive follow-up appointments are paramount to positive outcomes as well as meeting this HEDIS measure. Telehealth visits can greatly increase the likelihood of keeping follow-up appointments leading to reduced numbers of rehospitalization and more favorable outcomes for these patients. To learn more about the FUH HEDIS measure, visit the National Committee for Quality Assurance (NCQA) website.
Visit the Drug Lists page at https://www.anthem.com for more information on:
- Copayment/coinsurance requirements and their applicable drug classes.
- Drug lists and changes.
- Prior authorization criteria.
- Procedures for generic substitution.
- Therapeutic interchange.
- Step therapy or other management methods subject to prescribing decisions.
- Any other requirements, restrictions, or limitations that apply to using certain drugs.
The Commercial and Exchange drug lists are posted to the website quarterly on the first day of the month in January, April, July, and October.
To locate Exchange Select Formulary and pharmacy information, scroll down to Select Drug Lists. This drug list is also reviewed and updated regularly as needed.
FEP Pharmacy updates and other pharmacy related information may be accessed at www.fepblue.org > Pharmacy Benefits.
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