Please note that the important message below from Bryony Winn – President, Health Solutions – applies to our Commercial, Medicaid and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem).

I am pleased to announce that Anthem, Inc. shareholders voted to approve the company's name change from Anthem, Inc. to Elevance Health, Inc. (NYSE Ticker Symbol — ELV) effective June 28, 2022.

Here is what you can expect:

• A bold new vision for the future of health We chose the name Elevance Health to better reflect our business as we elevate the importance of whole health and advance health beyond healthcare for consumers, their families, and our shared communities. This new vision fuels our transformation from a traditional health benefits organization to a health company that looks beyond the traditional scope of physical health.
• No action is needed by you, and we remain committed to helping you deliver whole-person care for your patients, our customers. Importantly, there is no impact or changes to your contract, reimbursement, or level of support. For your patients, it will not change their plan or coverage or change how they receive their medications. Provider networks will not be changing.
• A more holistic approach to health that improves affordability and outcomes. Bringing together a broad portfolio of health plans, including pharmacy, behavioral, clinical, and complex care provider partners, we can deliver integrated, holistic health solutions to meet the increasing needs of our customers and care provider partners. This includes two notable changes:
  • Our healthcare service partners will operate under a new brand called Carelon. This includes Beacon Health Options, AIM Specialty Health®, CareMore, and IngenioRx. You can find us at Carelon.com. 
  • IngenioRx, our pharmacy benefit management partner, will become CarelonRx on January 1, 2023. This name change will not impact your patient’s benefits, coverage, or how their medications are filled. We will communicate detailed information about this change soon.
• A simpler brand portfolio that makes it easier to do business with us. We have streamlined and simplified the complexity of our health plan and service businesses and reduced the number of brands we have in the market, so our partners and customers clearly understand where we serve, who we serve, and what our brands do.

What does this mean for care providers?

We will operate as Anthem Blue Cross or Anthem Blue Cross and Blue Shield in our 14 Blue-licensed markets. Our existing Anthem-branded health plans are not changing and will continue to operate in their current states. There will be no impact to plans, coverage, or level of support.

Looking forward together

As your partner, we will continue to keep you updated with new information as soon as it becomes available. In the meantime, you can visit us at ElevanceHealth.com or contact your provider representative with any questions. Thank you for joining us on this exciting path forward as we reimagine what is possible for every moment of health.

Sincerely,

Bryony Winn

President, Health Solutions

COBCBS-CRCM-001853-22

Current provider directory information helps Anthem Blue Cross and Blue Shield members find the most up-to-date information available. As a partner in the care of our members, we ask that you review your online provider directory information regularly and provide updates as needed.

If changes are needed, please take the time to update your information by submitting updates and corrections to us on our online Provider Maintenance Form. Online update options include:

• Adding/changing 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.

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. Thank you for doing your part in keeping our provider directories current.

Effective for all claims received on or after August 1, 2022, in accordance with the Anthem Blue Cross and Blue Shield (Anthem) reimbursement policy titled Implant — Facility, we will implement additional steps to review claims submitted by facilities that inappropriately include supply HCPCS codes (HCPCS codes for catheters, needles, guidewires) billed with implant revenue codes (for example, 0278).

Anthem considers implants to be medical devices that remain in the member’s body upon discharge from the procedure. Therefore, supplies are not considered implants. Claims for supplies should be submitted with the appropriate revenue code(s). Claim lines billed inappropriately will be denied. Providers can resubmit claim for supplies using the appropriate revenue code(s).

If you have questions about this policy, contact your contract manager or Provider Experience representative.

We are enhancing our outpatient facility editing to help align with correct coding guidelines for usage of HCPCS code G0463. The code description for G0463 is “hospital outpatient clinic visit or assessment and management of a patient”. Based on this code description, HCPCS code G0463, should only be billed with revenue codes which support the billing of clinic visits/assessment and management services. When G0463 is billed with an inappropriate revenue code, it will be denied. For assistance with coding guidelines, the National Uniform Billing Committee (NUBC) is a valuable resource.

MULTI-BCBS-COMM-002028-22-CPN1882

This communication applies to the Commercial and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem).

In an effort to deliver on Anthem’s purpose to improve the health of humanity, we now have a program for in-home patient care for acute conditions.

Anthem’s Hospital in Home program can advise capable, innovative hospital partners in developing their own hospital in home programs. Once implemented, patients can recover in a more comfortable environment, allowing hospitals to keep beds available for patients with more complex needs.

Inpatient level of care in the home can be a welcome alternative to traditional hospital settings. Patients may find acute care at home to be more convenient and less stressful, and studies have shown acute care at home can be safe and allow for smoother transition to self-care management after the acute illness. Hospital in Home clinical trials demonstrate a 25% decrease in readmissions and a 50% reduction in time spent in bed.¹

Anthem’s Hospital in Home program has a set of minimum requirements that are designed to promote patient safety. These requirements include aspects of the member’s home environment, the clinical scenario, remote monitoring capabilities, and plans for program evaluation.

Please contact your Anthem contracting representative to learn more about Anthem’s Hospital in Home program.

1  Levine, D. M., Ouchi, K., Blanchfield, B., Saenz, A., Burke, K., Paz, M., Diamond, K., Pu, C. T., & Schnipper, J. L. (2020). Hospital-Level Care at Home for Acutely Ill Adults: A Randomized Controlled Trial. Annals of internal medicine, 172(2), 77–85. https://doi.org/10.7326/M19-0600.
MULTI-BCBS-CRCM-001819-22

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 in Colorado.

Unfortunately, there are certain non-participating labs that are offering to waive or cap co-payments, coinsurance, or deductibles to our members 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 Providers Overview. Select Find Resources in Your State and pick Colorado. From the Provider Home tab, select the enter button from the blue box on the left side of page titled Find a Doctor.

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 provides 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:

Note: This relationship with LabCorp does not affect network hospital-based lab service providers, contracted pathologists, or contracted independent laboratories.

To find a LabCorp location near you, go to www.LabCorp.com or call one of the phone numbers below.

For information about specialized assays or about requirements for special collection kits and specimen handling, call LabCorp at 303-792-2600 or toll free at 888-LABCORP (888-522-2677).

* LabCorp is an independent company providing lab services on behalf of Anthem Blue Cross and Blue Shield.

In a recent study published by Pediatrics, economic hardship, school closing, and shutdowns led to sedentary lifestyles and increases in childhood obesity. The research analyzed doctor visits pre-pandemic then during the pandemic period, and the increases were dramatic. Overall obesity increased from 13.7% to 15.4% in patients 5 to 9 years. Increases from 1% in children aged 13 to 17 to 2.6% for those aged 5 to 9 years were observed.

The study recommended new approaches to Weight Assessment and Counseling. These include recommending virtual activities that promote increased physical activity. Focusing on ways to remain safe and active with outside activities, such as park visits, walks, and bike riding were also suggested.

The Centers for Disease Control and Prevention has a great resource called Ways to Promote Health with Preschoolers. This fun flyer shows how we can all work together to support a healthy lifestyle. You can download a copy here.

The HEDIS^® measure Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (WCC) requires a nutritional evaluation and pro-active guidance as part of a routine health visit:

• When counseling for nutrition, document current nutritional behavior, such as meal patterns, eating and diet habits, and weight counseling.
• When counseling for physical activity, document current physical activity behavior, such as exercise routine, participation in sports activities, bike riding and play groups.
• Handouts about nutrition and physical activity also count toward meeting this HEDIS measure when documented in the member’s health record.

HEDIS^® measure WCC looks at the percentage of members, 3 to 17 years of age, who had an outpatient visit with a PCP or OB/GYN and have documented evidence for all the following during the measurement year:

• Body mass index (BMI) percentile (percentage, not value).
• Counseling for nutrition.
• Counseling for physical activity.

Telehealth, virtual check-in, and telephone visits all meet the criteria for nutrition and physical activity counseling. Counseling does not need to take place only during a well-visit, WCC can also be completed during sick visits. Documenting guidance in your patient’s records is key.

Code services correctly to measure success.

These diagnosis and procedure codes are used to document BMI percentile, weight assessment, and counseling for nutrition and physical activity:

American Academy of Pediatrics. American Academy of Pediatrics raises concern about children’s nutrition and physical activity during pandemic. Available at: http://services.aap.org/en/news-room/news-releases/aap/2020/american-academy-of-pediatrics-raises-concern-about-childrens-nutrition-and-physical-activity-during-pandemic/. Accessed December 10, 2020.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
MULTI-BCBS-CM-002326-22-CPN-1916

3072F: new language about two-year compliance.

The Comprehensive Diabetes Care HEDIS^® measure Retinal Eye Exam (DRE) valuates the percent of adult members ages 18 to 75, with diabetes (type 1 and type 2), who had a retinal eye exam during the measurement year.

Changes to 3072F

The definition for the code 3072F (negative for retinopathy) has been redefined to low risk for retinopathy (no evidence of retinopathy in the prior year). This can be particularly confusing because it would not be used at the time of the exam. It would be used the following year, along with the exam coding for the current year, to indicate that retinopathy was not present the previous year.

A simpler coding solution

Using these three codes count toward the DRE measurement if they are billed in the current measurement year or the prior year. This means you can submit the appropriate code at the time of the exam, and it covers both years:

For more about diabetic retinopathy, visit CMS.gov or use this link to read more. 

Meeting the measurement for all diabetes care

These exams are also important in evaluating the overall health of diabetic patients, as well as meeting the Comprehensive Diabetes Care HEDIS measure:

• Hemoglobin A1c (HbA1c) testing

• HbA1c poor control (> 9.0%)
• HbA1c control (< 8.0%)
• Retinal Eye exam performed
• Blood Pressure control (< 140/90 mm Hg)

Record your efforts in the member’s medical records for the HbA1c tests and results, retinal eye exam, blood pressure, urine creatinine test, and the estimated glomerular filtration rate test. Meeting the mark and closing gaps in care is key to good health outcomes.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
MULTI-BCBS-CM-002331-22-CPN1921

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

Webinars are offered using Cisco WebEx. There is no cost to attend. Access to the internet, an email address, and telephone is 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. 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.

COBCBS-COMM-001228-22

Beginning with claims processed on or after August 1, 2022, Anthem Blue Cross and Blue Shield will implement additional steps to review claims for evaluation and management (E/M) services submitted by professional providers when a preventive service (CPT^® codes 99381 to 99397) is billed with a problem-oriented E/M service (CPT codes 99202 to 99215) and appended with Modifier 25 (for example, CPT code 99393 billed with CPT code 99213 to 99225).

According to the American Medical Association (AMA) CPT Guidelines, E/M services must be “significant and separately identifiable” in order to appropriately append Modifier 25. Based upon review of the submitted claim information, if the problem-oriented E/M service is determined not to be a significant, separately identifiable service from the preventive service, the problem-oriented E/M service will be bundled with the preventive service.

Providers that believe their medical record documentation supports a significant and separately identifiable E/M service should follow the Claims Payment Dispute process (including submission of such with the dispute) as outlined in the provider manual.

If you have questions on this program, contact your contract manager or Provider Experience.

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.

Practices 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 866-649-0669.

MULTI-BCBS-CARE-001242-22

Please continue to check for important Medicare Advantage updates at https://www.anthem.com/ca/provider/medicare-advantage/ for the latest Medicare Advantage information, including:

• New specialty pharmacy medical step therapy requirements