 Provider News ColoradoFebruary 2020 Anthem Provider News and Important Updates -- ColoradoWe are continuing our series of “Working with Anthem” webinars for 2020. These 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).
2020 Subject Specific Webinars -- February schedule
|
Topic:
|
Working with Anthem Webinars: Anthem.com "Reimagined" pages overview (Legacy pages retiring March 31, 2020) - CO
|
|
Date/Time:
|
Wednesday, February 26, 2020 at 12:00pm MT
|
|
Description:
|
Anthem.com has "reimagined" our public website pages over the last year with many changes for more provider friendly access to information.
Our legacy anthem.com pages will be retiring at the end of March, 2020. We want to ensure you know where all information is on our new "reimagined" pages prior to the legacy pages retiring.
Join us for a complete overview of the anthem.com public website and learn how to access such things as:
- Forms
- Medical Policies and Clinical Guidelines
- Reimbursement Policies
- Provider Manual - Find a Doctor tool (online Provider directory) - Electronic Data Interchange (EDI)
- Provider News - Provider Education and Training
- Contact Us information
- Escalation Contact List
- Prefix Reference List
- Join Our Networks
- Plus more!
|
|
Registration link:
|
https://anthem.webex.com/anthem/onstage/g.php?PRID=b6a696587e498199466cadc7231c908d
|
Webinars are offered using Cisco WebEx. There is no cost to attend. Access to the internet, an email address and telephone is all that's 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. We also will continue to offer our Fall Provider Seminars which will continue to cover a variety of topics in face-to-face and webinar options.
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”.
Event Recordings Note:
As we have a new registration link effective September 1, 2019, event recordings will be split into two URLs.
- Recordings after September 1, 2019 will be available from the current registration link, under the “Event Recordings” heading.
- Archived Event Recordings from January -- August 2019 are available here.
Anthem Blue Cross and Blue Shield (Anthem) announced in July that the AIM Rehabilitative Program was delayed. This message is sent to announce that the AIM Rehabilitative program for Anthem’s Commercial Membership will relaunch April 1, 2020. AIM Specialty Health® (AIM), a separate company, will perform prior authorization review of physical, occupational and speech therapy services. Requests may be submitted beginning March 16, 2020 via the AIM ProviderPortal for dates of service April 1st and after. The OrthoNet program is no longer active in applicable markets. Processes have been put in place to allow providers to continue to provide treatment and allow claims to process. Claims that were denied for no authorization in error after 7/1 will reprocess.
The AIM Rehab Program follows the Anthem Clinical Guidelines that state the services must be delivered by a qualified provider of therapy services acting within the scope of their licensure. Qualified providers acting within the scope of their license, including chiropractors, who intend to provide PT, OT or ST services should request prior authorization for those services through AIM.
Please note that if you are providing PT/OT/ST services to an Anthem Commercial member whose state of issuance is part of the AIM Rehab Program, you will be required to obtain an authorization.
NEW CHANGES TO AIM’S REHAB PROGRAM
This is to inform you that Anthem and AIM Specialty Health are working together to make improvements to the clinical review of PT/OT/ST Services when used to treat Autism Spectrum Disorder or Pervasive Developmental Delays as defined by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Currently, prior authorization is not required for PT, OT, or ST out-patient therapy services when receiving skilled treatment for Autism Spectrum Disorder or Pervasive Developmental Delays for members with Anthem commercial plan. You may file your claims without a prior authorization number if you are billing with one of the following ICD-10 codes: F84.0, F84.2, F84.3, F84.5, F84.8, or F84.9. Please note that benefit limits, if applicable, will still be applied. We will let you know when the AIM Rehab Program for Autism Spectrum Disorder or Pervasive Developmental Delay program is scheduled for implementation.
Anthem is also transitioning vendors for review of Rehabilitative Services for our *Medicare members to include out-patient PT, OT, and SLP, to AIM Specialty Health. The AIM Rehab program will now begin in April 2020. Prior authorization will not be required for the above mentioned services through March 2020. *This does not apply to members in the states of FL, NJ and NY for whom prior authorization will still be required. Please review the update in an upcoming notice for more information about the AIM Rehabilitative Program for Medicare members. Anthem Commercial Risk Adjustment (CRA) contracts with Inovalon -- an independent company that provides secure, clinical documentation services -- to help us comply with provisions of the Affordable Care Act (ACA) that require us to assess members’ relative health risk level and report to CMS on those conditions. Your offices have been receiving Inovalon SOAP ( Subjective; Objective; Assessment; and Plan – these are health assessments) packets all year long as part of our risk adjustment cycle, asking for the physicians’ help with completing health assessments for some of their patients who are our members.
Incentives for submitting SOAP Notes/Health Assessments
SOAP Notes/Health Assessments submitted as paper are eligible for a $50 incentive; SOAPs submitted electronically through Inovalon’s ePASS system are eligible for a $100 incentive.
Submission Deadline and Important Reminder
While the dates of service for the patient visits must have been within 2019, the SOAP Notes/Health Assessments can be submitted up until February 15, 2020. We will still pay the incentive payments for these submissions through February 15, 2020.
Questions or assistance with SOAP Notes/Health Assessments
Need help with ePASS or have questions? Simply email your inquiry to Inovalon at ePASSsupport@inovalon.com with your name, organization, contact information, and any questions that you might have. Trained representatives are available to assist you. If you prefer to reach Inovalon by phone, please call 1-877-448-8125, Monday - Friday, 8 am - 9 pm ET; Saturday - Sunday, 10 am - 6 pm ET.
If you have any questions regarding our risk adjustment process, please contact our CRA Network Education Representative who supports your area: Socorro.Carrasco@anthem.com.Anthem is collaborating with leading organizations on a new school-based initiative called Shine Light on Depression to help tackle the issue of teen depression and suicide in middle and high school youth nationwide. The Shine Light on Depression e-toolkit (e.g., website) will provide school communities with free, ready-to-use tools designed to raise awareness of depression and suicide prevention in a positive, fact-based, and inclusive manner. This approach will help build a community in which there is open discussion and appropriate vocabulary about the subject of depression and places it in the broader context of good mental health. The e-toolkit features customizable classroom lessons to empower educators to lead effective depression awareness programs, family-community workshop materials to help adults and families talk about how to support teens, and teen club resources that empower students to lead activities and help each other by talking and listening. With 24,053 secondary schools in the U.S., the Shine Light on Depression e-toolkit has the potential to impact large numbers of individuals who are at risk of depression and suicide and support schools in meeting state teaching mandates.
Visit Shine Light on Depression to learn more.
Shine Light on Depression is a unique collaboration of organizations committed to raising awareness of depression and suicide prevention among young people: American School Health Association, Anthem, Inc., Erika’s Lighthouse, JetBlue Airways Corporation, and the National Parent Teachers Association.
Effective with dates of service on and after April 1, 2020, and in accordance with the IngenioRx Pharmacy and Therapeutic (P&T) process, Anthem Blue Cross and Blue Shield (Anthem) will update its drug lists that support commercial health plans.
Updates include changes to drug tiers and the removal of medications from the formulary.
Please note, this update does not apply to the Select Drug List and does not impact Medicaid and Medicare plans.
To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing a drug on formulary or on a lower tier, if appropriate.
View a summary of changes here.
IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem.Category: Medicare
Effective May 1, 2020, Anthem Blue Cross and Blue Shield (Anthem) has updated the Modifier 62: Co‑Surgeons reimbursement policy to expand the current policy’s language, adding that Anthem does not consider surgeons performing different procedures during the same surgical session as co-surgeons, and Modifier 62 is not required.
Assistant surgeon and/or multiple procedures rules and fee reductions apply if a co-surgeon acts as an assistant in performing additional procedure(s) during the same surgical session.
Please note that assistant surgeon rules do not apply to procedures appropriately billed with Modifier 62.
Please visit www.anthem.com/medicareprovider to view the Modifier 62: Co-Surgeons reimbursement policy for additional information regarding percentages and reimbursement criteria.
Category: Medicare
CMS requires that all hospitals and critical access hospitals (CAHs) provide written notification and an oral explanation to individuals receiving observation services as outpatients for more than 24 hours.
Hospitals should use the OMB-approved standardized Medicare Outpatient Observation Notice (MOON), form CMS-10611. All hospitals and CAHs are still required to provide this statutorily required notification. The notice and accompanying instructions are available at https://go.cms.gov/391jZH9.
The MOON was developed to inform all Medicare beneficiaries, including Anthem Blue Cross and Blue Shield members, when they are an outpatient receiving observation services, and are not an inpatient of the hospital or CAH. The notice must include the reasons the individual is an outpatient receiving observation services and the implications of receiving outpatient services, such as required Medicare cost-sharing and post-hospitalization eligibility for Medicare coverage of skilled nursing facility services.
Hospitals and CAHs must deliver the notice no later than 36 hours after observation services are initiated or sooner if the individual is transferred, discharged or admitted.
|