 Provider News ColoradoJanuary 2022 Anthem Provider News and Important Updates - ColoradoParents may not understand the importance of taking their children to the doctor when they are healthy. The benefits are documented by the American Academy of Pediatrics1 as well as the Centers for Disease Control and Prevention2 and it all starts with a recommendation by you, the trusted physician. Share these benefits with parents during regularly scheduled well-visits, or even during sick visits, to reinforce the importance of staying on track:
- Regular wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.
- Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.
- Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.
- Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.
Measure up: Well-Child Visits in the first 30 months of life (W30)
This HEDIS® measure is described as the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months. These rates are reported:
- Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.
- Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.
Tips
- Telehealth visits are acceptable in meeting the measurement requirements.
- Consider scheduling well-child visits in advance of the child reaching the age for the visit.
Coding
- ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2
- HCPCS: G0438-G0439, S0302
- CPT: 99381-99382, 99391-99392, 99461
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 – January schedule
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.
To view the 2022 benefits and changes for the Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program® (FEP), go to fepblue.org then click Tools & Resources at the top of the page, and then click Brochures & Resources. Here you will find Plan Brochures, Plan Summaries, and Quick Reference Guides on information for year 2022. For questions, please contact FEP Customer Service at: 800-852-5957.
Routinely, the Centers for Medicare & Medicaid Services (CMS) issue revisions to the average sales price (ASP) fee schedules regarding drug pricing. To that end, CMS is supplying the first quarter fee schedule with an effective date of January 1, 2022.
These fee schedules will go into effect with Anthem Blue Cross and Blue Shield (Anthem) on February 1, 2022. To view the ASP fee schedule, please visit the CMS website at http://www.cms.hhs.gov/McrPartBDrugAvgSalesPrice/.
Effective January 1, 2022, IngenioRx/CVS Specialty Pharmacy* will no longer distribute the brand name drug Botox®. However, Botox will still be available to Anthem Blue Cross and Blue Shield members through other vendors.
Please note:
- This is not a change in member benefits. This is a change in the Botox vendor only.
- If the member is not using IngenioRx/CVS Specialty Pharmacy to obtain Botox, no action is needed.
For Botox managed under a Medicare member’s part B (medical) benefit
Providers should be using buy and bill for any Medicare member who currently receive Botox through their part B (medical) benefit. If your patient is receiving Botox using their part B benefit and is receiving their prescription from IngenioRx/CVS Specialty pharmacy, effective January 1, 2022, IngenioRx/CVS Specialty will no longer filled the prescription. As of January 1, 2022, you will need to buy this drug and bill your patient’s health plan.
If you have questions regarding a Medicare member’s part B benefits, call Provider Services using the information on the back of the member’s ID card.
For Botox managed under a Medicare member’s part D (pharmacy) benefit
Effective January 1, 2022, Medicare members who currently receive Botox through IngenioRx/CVS Specialty Pharmacy using their part D (pharmacy) benefit must change to another in-network specialty or retail pharmacy that can obtain and dispense Botox.
If you have questions regarding a Medicare member’s part D benefit, call Pharmacy Member Services using the information on the back of the member’s ID card.
The HEDIS® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care services.
The ECDS Reporting Standard provides a method to collect, and report structured electronic clinical data for HEDIS quality measurement and improvement.
Benefits to providers:
- Reduced burden of medical record review for quality reporting
- Improved health outcomes and care quality due to greater insights for more specific patient-centered care
ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures.
Learn more about NCQA’s digital quality system and what it means to you and your practice, at the following link: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.
ECDS measures
The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure. In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.
For HEDIS measurement year 2022, the following measures can be reported using ECDS:
- Childhood Immunization Status (CIS-E) *
- Immunizations for Adolescents (IMA-E) *
- Breast Cancer Screening (BCS-E)
Effective December 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) will prefer the referring physician name and NPI to be included on professional claims for home infusion therapy (HIT) services in fields 17 and 17a on the CMS-1500 Claim Form.
Providers should report the referring physician information in accordance with the Anthem guidelines in the Electronic Data Interchange (EDI) Companion Guide for claims submitted electronically.
Thank you for your assistance in our ongoing efforts to promote accurate claims processing and payment. We continue to be dedicated to delivering access to quality care for our members, providing higher value to our customers, and helping improve the health of our communities.
If you have questions regarding this process, contact your Network Manager.
|