 Provider News ColoradoFebruary 2021 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).
2021 Subject Specific Webinars -- February schedule
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Topic:
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Anthem.com Overview
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Date/Time:
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Thursday, February 25, 2021, 12pm MT
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Description:
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Join us for a complete overview of the Anthem.com public website and learn how to easily navigate to useful self-service tools and resources such as:
- Forms (including Networks at a Glance, and Networks Overview)
- Medical Policies and Clinical Guidelines
- Reimbursement Policies
- Provider Manual
- Find Care tool (online Provider directory)
- Electronic Data Interchange (EDI)
- Provider News - Provider Education and Training
- Contact Us information (including our Escalation Contact List)
- Join Our Networks
- Plus more!
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Registration link:
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https://anthem.webex.com/anthem/onstage/g.php?PRID=b6a696587e498199466cadc7231c908d
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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 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”.
Note: Even if you are unavailable to attend, please register to ensure you receive the event recording password once available as it’s distributed to all that register.
Anthem Blue Cross and Blue Shield (Anthem) will begin publishing a new indicator in our online provider directories to help members easily identify professional providers who offer telehealth services.
We encourage providers who offer telehealth services to utilize the online Provider Maintenance Form to notify us and we will add a telehealth indicator to your online provider directory profile.
Visit anthem.com to locate the Provider Maintenance Form. Please contact Provider Services if you have any questions.
This is a reminder to ensure that you are referring Anthem members to participating labs. LabCorp is our preferred lab provider and offers a Single Source Solution to your testing needs. The relationship with LabCorp does not affect network hospital-based lab service providers, contracted pathologists, or contracted independent laboratories. Physicians may continue to refer to all par providers as they have in the past.
Not only does your Anthem agreement obligate you to refer to participating labs where available, but members will only receive their full benefits from participating providers. As a result, referring your patient and our member to a non-participating lab may expose them to a greater financial responsibility. As a reminder, Quest Diagnostics is a non-participating laboratory for all lines of business.
Unfortunately, there are certain non-participating labs that are offering to waive or cap co-payments, coinsurance or deductibles to our members in order to increase their overall revenue. These practices undermine member benefits and may encourage over-utilization of services.
These billing practices are also questionable in their legality. Such a practice may present violations under state or federal anti-kickback laws, and may constitute abuse of health insurance under the Colorado criminal code.
For a listing of Anthem participating laboratories, please check our online directory. Go to anthem.com. Choose Select Providers, and pick your state if you haven't done so already. Under the Provider Resources heading, select Find Care.
Note: When searching for laboratory, pathology, or radiology services, under the field “I am looking for a:” select Lab/Pathology/Radiology; and then under the field “Who specializes in:”, select Laboratories, Pathology, or Radiology as appropriate for your inquiry.
LabCorp is our preferred lab provider and offers a Single Source Solution to your testing needs:
LabCorp is capable of providing services that range from routine testing, such as basic blood counts and cholesterol tests, to highly complex diagnosing of genetic conditions, cancers, and other rare diseases. LabCorp has specialized laboratories which cover the following areas of testing:
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· Allergy Program
· Cancer Testing
· Cardiovascular Disease
· Companion Diagnostics
· Dermatology
· Diabetes
· DNA Testing
· Endocrine Disorders
· Esoteric Coagulation
· Gastroenterology
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· Genetic Testing
· Genetic Counseling
· Genomics
· HLA Lab for National Marrow Donor Program
· Hematopathology
· Infectious Disease
· Immunology
· Liver Disease
· Kidney Disease
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· Medical Drug Monitoring
· Molecular Diagnostics
· Newborn Screening
· Pain Management
· Pathology Expertise w/range of Subspecialties
· Pharmacogenomics
· Preimplantation Genetic Diagnosis
· Reproductive Health
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· Obstetrics
/Gynecology
· Oncology
· Toxicology
· Whole Exome Sequencing
· Virology
· Women’s Health
· Urology
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Note: This relationship with LabCorp does not affect network hospital-based lab service providers, contracted pathologists, or contracted independent laboratories.
Effective with dates of service on and after April 1, 2021, and in accordance with the IngenioRx Pharmacy and Therapeutics (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.
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, and any other requirements, restrictions, or limitations that apply to using certain drugs, visit anthem.com/pharmacyinformation. The commercial and marketplace drug lists are posted to the web site quarterly (the first of the month for January, April, July and October).
To locate “Marketplace 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.
On November 15, 2019, February 21, 2020, May 15, 2020, August 21, 2020, August 28, 2020, and September 24, 2020, the Pharmacy and Therapeutics (P&T) Committee approved Clinical Criteria applicable to the medical drug benefit for Anthem Blue Cross and Blue Shield (Anthem) and AMH Health, LLC (AMH Health). These policies were developed, revised or reviewed to support clinical coding edits.
The Clinical Criteria is publicly available on the provider websites, and the effective dates will be reflected in the Clinical Criteria Web Posting September and October 2020 Anthem and Clinical Criteria Web Posting September and October 2020 AMH Health. Visit Clinical Criteria to search for specific policies.
If you have questions or would like additional information, use this email.
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