We 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 -- March schedule

 

Topic:	Availity.com Tools and Functionality Overview
Date/Time:	Tuesday, March 30, 2021, 12pm MT
Description:	Learn about tools and functionality available on Availity such as: Availity Registration and login Basic Transactions: Eligibility and Benefits inquiry Electronic Member ID cards Authorization requests/inquiries via Interactive Care Reviewer (ICR) Claim Submissions Medical Attachments Claim Status Inquiry Access to on demand training such as Onboarding Payer Spaces: Chat with Payer Claim History Clear Claim Connection Fee Schedule tool Remittance Inquiry 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”.

 

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. 

 

 

962-0221-PN-CO

To help ensure accuracy and eliminate delays in the adjudication of your claims, the itemized bill must be included with qualifying claim submissions. Submitting an itemized bill (unsolicited* medical attachment) for a high dollar claim just got easier!

 

To submit an itemized bill (unsolicited medical attachment):

1. Log in to Availity Portal
2. Select Claims & Payments | Attachments – New
3. Select Send Attachment
4. Under Request for Information, select No, if you are including the supplemental information/attachment for an 837 claim PWK. (see example below)

 

 

 

 

Providers can also submit a claim attachment using the Availity Portal for solicited** medical attachments.

 

To submit supporting documentation in response to a formal (solicited) request from the payer:

• Log in to Availity Portal
• Select Claims & Payments | Attachments – New
• Select Send Attachment
• Under the Request for Information, select Yes, if you are responding to a request from the health plan or need to submit documentation for a specific claim number (see example below)
• Add supporting documentation and reason
• Submit

Additionally, if you attended a previous webinar, we have updated information on submitting an EDI 837 batch that includes a PWK segment in loops 2300/2400. The update is regarding the linkage between the electronic claim and your supplemental documentation that can be submitted through the Availity portal.

 

What does this mean for you?

You may now submit attachments electronically (EDI) using the PWK segment to specify that documents are being submitted in support of the claim and no additional face sheet or coversheet is needed.

 

Here are the steps:

• Log in to Availity Portal
• Select Claims & Payments I Attachments - New
• From the Inbox tab, select the appropriate claim or open the request in your work queue
• Add files with supporting documentation
• Submit

 

Get Trained

• Attend an Availity-hosted webinar to learn more about all capabilities. You can register for an upcoming live webinar hosted by Availity here, or
• Log into Availity.com and select Help & Training | Get Trained to open the Availity Learning Center in a new tab (it is your dedicated ALC account).

• Search by keyword (Medattach) to find on-demand and live training options
• Select Enroll to enroll for a course and then go to your Dashboard to access it any time

 

Get started today with these wide-ranging capability enhancements to transform your business operations to a quick, secure, paperless and simple process to fulfill medical records requests electronically through Availity.

 

*Unsolicited attachment: Documentation submitted without a formal request from the payer

**Solicited attachment: Documentation submitted in response to a specific request from payer

 

 

1017-0321-PN-CONV

Material Adverse Change (MAC)

Site of Care medical necessity reviews for long-acting colony-stimulating factors begin June 1, 2021

 

 

1019-0321-PN-CONV

Effective for dates of service on and after April 1, 2021, the following specialty pharmacy drugs and corresponding codes from current Clinical Criteria noted below will be included in our medical step therapy precertification review process. Step therapy review applies upon precertification initiation or renewal in addition to the current medical necessity review.

 

Clinical Criteria	Status	Drug(s)	HCPCS codes
ING-CC-0011	Nonpreferred	Ocrevus®, injection, 1 mg	J2350
ING-CC-0160	Nonpreferred	Eptinezumab, injection 1 mg	J3032

 

The Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.

 

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative.

 

 

ABSCRNU-0193-20

Anthem Blue Cross and Blue Shield 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 use the online Provider Maintenance Form to notify us, and we will add a telehealth indicator to your online provider directory profile.

 

Visit http://www.anthem.com to locate the Provider Maintenance Form. Please contact Provider Services if you have any questions.

 

• Colorado Provider Maintenance Form

 

 

ABSCRNU-0203-20

The Medical Policies, Clinical Utilization Management (UM) Guidelines and Third-Party Criteria below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. Please note: The Medical Policies and Clinical UM Guidelines below are followed in the absence of Medicare guidance.

 

Please share this notice with other members of your practice and office staff.

 

To view a guideline, visit https://www11.anthem.com/search.html.

 

Notes/updates:

Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive.

*GENE.00055 – Gene Expression Profiling for Risk Stratification of Inflammatory Bowel Disease (IBD) Severity

Gene expression profiling for risk stratification of inflammatory bowel disease (IBD) severity, including use of PredictSURE IBD, is considered investigational and not medically necessary for all indications

*LAB.00037 – Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS)

Serological testing for biomarkers of irritable bowel syndrome (for example, CdtB and

anti-vinculin), using tests such as, IBSDetex, ibs-smart or IBSchek, is considered investigational and not medically necessary for screening, diagnosis or management of irritable bowel syndrome, and for all other indications

*DME.00011 – Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices

Revised scope to only include non-implantable devices and moved content addressing implantable devices to SURG.00158

Added “non-implantable” to bullet point on percutaneous neuromodulation therapy

Added percutaneous electrical nerve field stimulation (PENFS) as investigational and not medically necessary for all indications

*SURG.00062 – Vein Embolization as a Treatment for Pelvic Congestion Syndrome and Varicocele

Expanded scope to include percutaneous testicular vein embolization for varicocele and added embolization of the testicular (spermatic) veins as investigational and not medically necessary as a treatment of testicular varicocele

*CG-LAB-15 – Red Blood Cell Folic Acid Testing

RBC folic acid testing is considered not medically necessary in all cases

*CG-LAB-16 – Serum Amylase Testing

Serum amylase testing is considered not medically necessary for acute and chronic pancreatitis and all other conditions

*CG-GENE-04 – Molecular Marker Evaluation of Thyroid Nodules

Added the Afirma Xpression Atlas as not medically necessary

SURG.00158 – Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

A new Medical Policy was created from content contained in DME.00011.

There are no changes to the policy content.

Publish date is December 16, 2020.

CG-GENE-21 – Cell-Free Fetal DNA-Based Prenatal Testing

A new Clinical Guideline was created from content contained in GENE.00026.

There are no changes to the guideline content.

Publish date is December 16, 2020.

 

Medical Policies

On November 5, 2020, the medical policy and technology assessment committee (MPTAC) approved the following Medical Policies applicable to Anthem Blue Cross and Blue Shield (Anthem). These guidelines take effect March 8, 2021.

 

Publish date	Medical Policy number	Medical Policy title	New or revised
12/16/2020	*GENE.00055	Gene Expression Profiling for Risk Stratification of Inflammatory Bowel Disease (IBD) Severity	New
12/16/2020	*LAB.00037	Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS)	New
11/12/2020	ANC.00009	Cosmetic and Reconstructive Services of the Trunk and Groin	Revised
12/16/2020	*DME.00011	Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices	Revised
11/12/2020	GENE.00052	Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling	Revised
11/12/2020	MED.00129	Gene Therapy for Spinal Muscular Atrophy	Revised
12/16/2020	SURG.00011	Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting	Revised
12/16/2020	*SURG.00062	Vein Embolization as a Treatment for Pelvic Congestion Syndrome and Varicocele	Revised

 

Clinical UM Guidelines

On November 5, 2020, the MPTAC approved the following Clinical UM Guidelines applicable to Anthem. These guidelines were adopted by the medical operations committee for Anthem members on November 19, 2020. These guidelines take effect March 8, 2021.

 

Publish date	Clinical UM Guideline number	Clinical UM Guideline title	New or revised
12/16/2020	*CG-LAB-15	Red Blood Cell Folic Acid Testing	New
12/16/2020	*CG-LAB-16	Serum Amylase Testing	New
11/12/2020	CG-DME-42	Non-implantable Insulin Infusion and Blood Glucose Monitoring Devices	Revised
12/16/2020	*CG-GENE-04	Molecular Marker Evaluation of Thyroid Nodules	Revised
12/16/2020	CG-GENE-18	Genetic Testing for TP53 Mutations	Revised
12/16/2020	CG-GENE-20	Epidermal Growth Factor Receptor (EGFR) Testing	Revised
11/12/2020	CG-MED-87	Single Photon Emission Computed Tomography Scans for Noncardiovascular Indications	Revised

 

 

ABSCRNU-0206-21

Please continue to check Important Medicare Advantage Updates at anthem.com/medicareprovider for the latest Medicare Advantage information, including:

 

• MCG Care Guidelines 24th edition customization
• DME checklist of information needed from providers

 

 

ABSCRNU-0201-20

ABSCRNU-0205-21