 Provider News ColoradoFebruary 2022 Anthem Provider News and Important Updates - ColoradoThe 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. We are asking you to review your online provider directory information to help ensure Anthem Blue Cross and Blue Shield (Anthem) members can locate the most current information for in-network providers and facilities.
You can help us ensure your online provider directory information is current by:
- Reviewing your online provider directory information on a regular basis to ensure it is correct. You can check your directory listing on Anthem’s Find Care tool. Consumers, members, brokers, and providers use the Find Care tool to identify in-network physicians and other healthcare providers supporting member health plans. To ensure we have your most current and accurate information, please take a moment to access Find Care. Go to anthem.com/ca, select Providers, then under Provider Overview, choose Find Care.
- Submitting 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
- 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 receipt of your request. Visit the Provider Maintenance Form landing page for complete instructions.
National Wear Red Day is a great way to keep heart aware. It is also a great opportunity to have a conversation with your patients about their heart health. The Centers for Disease Control and Prevention (CDC) has information you can share with your patients, including a helpful Know the Facts about Heart Disease flyer that’s free for health care professionals.
Controlling high blood pressure, diabetes, extra weight and unhealthy diets are heart disease contributors that you can help your patients recognize. For information about these heart disease risks to share with your patients, use the CDC website for toolkits, flyers and give-a-ways.
Measure Up: Controlling High Blood Pressure (CBP)
Known as the “silent killer,” high blood pressure or hypertension increases the risk of heart disease.
The HEDIS® measure CBP looks at the percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (140/90) in the measurement year. Record all blood pressure readings and the dates they were taken being sure to record the exact reading. Blood pressure readings captured during a telehealth, virtual care, telephone or e-visit should also be recorded.
Measure Up: Statin Therapy for Patients with Cardiovascular Disease and Diabetes (SPC/SPD)
Statins are effective at lowering cholesterol and protecting against a heart attach and stroke. Patients with diabetes also have elevated cardiovascular risk.
- Statin therapy for patients with cardiovascular disease (STC). HEDIS measure assesses males 21-75 years of age and females 40-75 years of age who have clinical atherosclerotic cardiovascular disease and who received and adhered to statin therapy.
- Statin therapy for patients with diabetes (STD) assesses adults 40-75 years of age who have diabetes and who do not have clinical ASCVD, who received and adhered to statin therapy.
Adherence to prescribed medication is key to patient care and SPC/SPD measure success.
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 – February schedule
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Topic:
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Anthem.com Overview
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Date/Time:
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Wednesday, February 23, 2022
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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: Event Recordings will require a password. Please register for the event, even if you are unable to attend, to ensure you will be notified of the Event Recording and password once it is available.
The Cancer Care Navigator (CCN) program is a comprehensive cancer support solution for oncologists and Anthem Blue Cross and Blue Shield (Anthem) members who are at high risk for complications during treatment. This program is aimed at helping to simplify the complexities of cancer care for members.
Providers are given a single point of contact to connect the practice to the right people at Anthem to help lessen administrative burdens. CCN also gives the practice access to Anthem’s advanced predictive analytics to help identify patients at high risk for complications, in turn allowing providers the opportunity to take preventive action and guide targeted interventions.
Patients are provided with a wealth of support through supplemental services (dietitians, pharmacists, etc.), medication adherence assistance, individualized care plans, and goal setting, as well as after-hours telephonic and digital support.
CCN is the ultimate support service to improve the care experience and quality of life to allow patients time to focus on overall health and well-being. Please feel free to reach out to the CCN team at 1-833-649-0669.
The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is an annual standardized survey conducted starting February 2022 through May 2022 to assess consumers’ experience with their provider and health plan. A random sample of your adult or child patients may get the survey. Over half of the questions used for scoring are directly impacted by providers. These questions are:
- When you needed care right way, how often did you get care as soon as you needed?
- How often did you get an appointment for a check-up or routine care as soon as you needed?
- How often was it easy to get the care, tests, or treatment you needed?
- How often did you get an appointment to see a specialist as soon as you needed?
- How often did your personal doctor seem informed and up-to-date about the care you got from other doctors or other health providers?
- How would you rate your personal doctor?
- How would you rate the specialist you see most often?
- How would you rate all your health care in the last 6 months?
Interested in how you can improve CAHPS performance? Anthem Blue Cross and Blue Shield offers an online course for providers and office staff designed to learn how to improve communication skills, build patient trust and commitment, and expand your knowledge of the CAHPS survey. The Improving the Patient Experience course is available at no cost and is eligible for one CME credit by the American Academy of Family Physicians. It can be accessed at: https://www.mydiversepatients.com/le-ptexp.html.
Visit the Drug Lists page on 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 marketplace drug lists are posted to the website quarterly on the first day of the month in January, April, July, and October.
To locate Marketplace formularies 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.
Effective November 1, 2021, EnrollSafe* at https://enrollsafe.payeehub.org replaced
Enrollhub® from the Council for Affordable Quality Healthcare, Inc. (CAQH) as the electronic funds transfer (EFT) enrollment website at no cost to Anthem Blue Cross and Blue Shield providers.
EnrollSafe is safe, secure, and available 24-hours a day
Log onto the EnrollSafe enrollment hub at https://enrollsafe.payeehub.org to enroll in EFT. You will be directed through the EnrollSafe secure website to the Registration page, where you will provide the required information to create an account and then Enroll to supply your banking information.
Already enrolled in EFT through CAQH Enrollhub?
If you were previously enrolled in EFT through CAQH Enrollhub, no action is needed unless you are making changes. Your EFT enrollment information will not change as a result of the new enrollment hub.
If you have changes to make, use https://enrollsafe.payeehub.org to update your account.
For more information or additional questions regarding the EnrollSafe Enrollment Hub portal, the provider can contact the Support team by calling 877-882-0384, Monday through Friday 9 a.m. to 8 p.m. ET.
In April 2022, Anthem Blue Cross and Blue Shield (Anthem) will replace its current internal provider demographic management system with a new Strategic Provider System (SPS). This investment in advanced technology will significantly improve provider data accuracy and transparency, enhancing the overall provider experience. New system features will strengthen our ability to match submitted claims for more accurate pricing and processing.
System upgrades special notice
During the first phase of our improvements, Anthem will implement system upgrades April 1, 2022, through April 8, 2022. Provider updates submitted during this period will be processed after April 8, 2022. We appreciate your patience as we upgrade our systems.
Next steps: new Provider Data Management coming soon
Beginning in June 2022, the second phase of our improvement initiative will be integration with Availity’s* Provider Data Management (PDM) functionality, which will roll out in phases. This single, easy-to-use portal, will allow providers to view, maintain, update, and attest to the accuracy of provider demographic information for Anthem. The Availity portal will enable providers to complete required verifications online via a simplified quick verification procedure – eliminating the need to fax, email, or use separate online forms. This service will replace the way you currently send Anthem your demographic updates.
Get ready for the change today
If your organization is not already registered on the Availity Portal, we strongly encourage you to get started right away. Your organization’s designated administrator can go to https://www.availity.com to register and find other helpful information about using Availity. Availity is Anthem’s secure provider portal platform where providers can enjoy the convenience of digital transactions, including prior authorization submissions, claims submission and benefit and eligibility look-up.
For questions about Availity, call 800-AVAILITY (800-282-4548).
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