We are continuing our series of “Working with Anthem” webinars for 2019.  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).

2019 Subject Specific Webinars - May schedule

Topic:	Availity tools and functionality overview
Date/Time:	May 21, 12pm MT
Description:	Learn about tools and functionality available on Availity such as: Clear Claim Connection Fee Schedule Remittance Inquiry Secure Messaging Electronic Member ID cards Medical Attachments for solicited Medical Record Requests Online authorizations through Interactive Care Reviewer (ICR) Health Assessments for Commercial Risk Adjustment Access to on demand training such as Onboarding
Registration link:	https://antheminc.webex.com/antheminc/onstage/g.php?PRID=9ada1c60117342da8bf0ff05a4f4d9c1

 

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.

Have you had more patients present with their ID card on their smartphone? We want to remind you of the ways you can access your own copy of their ID card.

 

In the October 2017 issue of our Provider Newsletter, Anthem informed you about our mobile app called Anthem Anywhere that allows members to manage their benefits on their smart phones, including the option of an electronic only version of their ID cards.  We want to ensure a member’s electronic only ID card meets your needs. 

 

Based on member requests and growing trends, we anticipate that by the year 2020, nearly 50% of our Local Plan members may choose the electronic ID card option, so we urge you to start using the available retrieval tools today. 

 

Provider options for obtaining a copy of an electronic Member ID card

 

• Online -- through the Availity Portal:  Providers also have the option to view Anthem Member ID Cards online (and print if needed) from the Availity Portal at availity.com.  When conducting an Eligibility and Benefits (E&B) Inquiry -- from the E&B Results page, select the blue button titled View Member ID Card .  (Currently excludes BlueCard®, Federal Employee Program® (FEP) and some health plans’ Medicare Advantage and Medicaid members.)

 

Note: as with all E&B Inquiries on Availity, providers must have the member ID number (including the three-character prefix) and one or more search options of date of birth, first name and last name.

 

• Email or Fax: Members can email/fax the card from his/her phone.  When members are viewing their ID Card on their phone, they will select the email or fax icon to forward their ID card.

 

These options are available for your patients who are members covered by our affiliated health plans in CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI, VA, and NY. 

 

Members are still required to have a copy of their card in one format or another, whether hard copy or electronic, in order for services to be rendered.  See our Quick Reference Guide for further details.

 

Quick Reference Guide

See our Electronic Member ID Cards – Quick Reference Guide for more details and information on:

• Frequently Asked Questions
• Details on provider options for obtaining a copy of an electronic Member ID card
• Sample electronic Member ID cards  

Now you will be able to access enhancements to the Benefit / Service types when utilizing the Eligibility and Benefits Inquiry tool via the Availity Portal for many Anthem members.

 

You may have noticed fairly new additions to Benefit / Service Types that include:

• Medically Related Transportation
• Long Term Care
• Acupuncture
• Respite Care
• Dermatology
• Sleep Study Therapy (found under Diagnostic Medical)
• Allergy Testing

 

Although there is an extensive list of available Benefit / Service types when submitting an eligibility and benefits request, they vary by payer.  Some important points to know about when selecting service type:

 

• The Benefit / Service type field is populated with the last benefit type you selected.
• If you don’t see a specific benefit in the results, submit a new request and select the specific Benefit / Service type.
• You have the ability to inquire on 50 patients at one time using the “add multiple patients” feature.

 

In response to your feedback, we have added additional Benefit / Service types to share even more valuable information with you electronically.  So if your practice works with one of these new service types, now you will be able to view more detailed information on those services electronically. Check them out today.

 

“Working with Anthem” webinars

 

Don’t forget we are also hosting our “Working with Anthem” webinars and this month’s topic will be the Availity Tools and Functionality Overview.  We will have a guest presenter providing a live demo.  Check out our registration link to register today!

In the April 2019 edition of our newsletter, we announced the exciting updates we’ve made to the Medical Attachment submission tool. As you start using the updated medical attachment tool on the Availity Portal, you will notice the following changes from the information we shared in April:

 

• File size -- each attachment can be up to 10 MB, with a maximum of 30 MB as the file size limit for all attachments combined
• The addition of logos in your dashboard make it easy to quickly identify each payer
• The original Medical Attachment tool will be retired from the Availity Portal soon, so we encourage you to now start utilizing the new updated option titled ‘Attachments - New’. Once a date has been determined for the original Medical Attachment Tool retirement we will begin communication.

 

Other features of the updated medical attachment include:

 

• The ability to submit an itemized bill
• A different link tilted “Attachments - New” where you will now submit medical records when Anthem has requested additional information to process a claim
• A new link on the attachment page called “Send Attachment(s)” will allow you to start the process
• A record history of each entry provides you increased visibility of your submission

 

The Medical Attachment tool makes the process of submitting an electronic documentation in support of a claim, simple and streamlined. You can use your tax identification number (TIN) or your NPI to register and submit solicited (requested by Anthem) medical record attachments through the Availity Portal.

 

NOTE: We will continue to keep you informed of upcoming changes to the “Attachments – New” platform as we progress toward streamlining our electronic documentation functionality.

 

How to Access solicited Medical Attachments for Your Office

 

Availity Administrator, complete these steps:

 

From My Account Dashboard, select Enrollments Center | Medical Attachments Setup, follow the prompts and complete the following sections:

 

1. Select Application | choose Medical Attachments Registration
2. Provider Management | Select Organization from the drop-down
   • Add NPIs and/or Tax IDs (Multiples can be added separated by spaces or semi-colons)
3. Assign User access by checking the box in front of the User’s name
   • Users may be removed by unchecking their name

 

Using Medical Attachments

 

Availity User, complete these steps:

 

1. Log in to www.availity.com
2. Select Claims and Payments | Attachments - New | Send Attachment(s)
3. Complete all required fields of the form
4. Attach supporting documentation
5. Submit

           

Need Training?

 

To access additional training for this Availity feature: Log in and select Help & Training | Get Trained to open the Availity Learning Center (ALC) Catalog in a new browser tab. It is your dedicated ALC account. Search the Catalog by keyword “attachments” to find training demo and on-demand courses. Choose your preferred training option, then select Enroll to enroll for a course.  Go to your Dashboard to access it any time.

 

“Working with Anthem” webinars

 

Don’t forget we are also hosting our “Working with Anthem” webinars and this month’s topic will be the Availity Tools and Functionality Overview.  Check out our registration link to register today!

In a continuation of our CRA reporting update articles throughout 2019, Anthem Blue Cross and Blue Shield (Anthem) requests your assistance with respect to our Commercial Risk Adjustment (CRA) reporting processes.

 

As a reminder, there are two approaches that we take (Retrospective and Prospective) to improve risk adjustment reporting accuracy.  We are focusing on performing appropriate interventions and chart reviews for patients with undocumented Hierarchical Condition Categories (HCC), to close the documentation and coding gaps that we are seeing with our members enrolled in our Affordable Care Act (ACA) compliant plans.

 

This month we’d like to focus on the Prospective approach, and the request to our Providers:

 

Anthem network providers -- usually primary care physicians -- may receive letters from our vendor, Inovalon, requesting that physicians:

 

1. schedule a comprehensive visit with patients identified to confirm or deny if previously coded or suspected diagnoses exists, and
   
   
2. submit a Health Assessment documenting the previously coded or suspected diagnoses (also called a SOAP Note -- Subjective, Objective, Assessment and Plan). 
   
   
   • Incentives for properly submitted Health Assessments (in addition to the office visit reimbursement):
     • $100 submitted electronically
     • $50 submitted vis fax

Health Assessment requests through Inovalon

 

We have engaged Inovalon -- an independent company that provides secure, clinical documentation services -- to help us comply with provisions of the ACA that require us to assess members’ relative health risk level.  In the coming weeks and months, Inovalon will be sending letters to providers as part of our risk adjustment cycle, asking for their help with completing health assessments for some of our members.

 

This year will bring a new round of assessments. As a reminder, chronic conditions must be coded every year, and we encourage you to code to the greatest level of specificity on all Anthem claim submissions.  If you have questions about the requests you receive, you can reach Inovalon directly at 1-866-682-6680.

 

Maximize your Incentive opportunity: submit electronically via Inovalon’s ePASS® tool

 

Join an ePASS webinar to learn how to submit a Health Assessment electronically and maximize your incentive opportunities.  They are offered every Wednesday from 3:00 - 4:00pm EST.  Register by sending an email to ePASSProviderRelations@inovalon.com with your name, organization, contact information and the date of the webinar you wish to attend.

 

• Teleconference: Dial 1-415-655-0002 (US Toll) and enter access code: 736 436 872  
• WebEx: Visit https://inovalonmeet.webex.com and enter meeting number: 736 436 872
• Once you join the call, live support is available at any time by dialing *0

 

Alternative reporting engagement

 

ePASS is our preferred method for submission for the Prospective approach. However to improve engagement and collaborate with our Providers who are not submitting via ePASS, we have identified other alternatives which may be helpful and provide more flexibility with your current processes.

 

If you are interested in any of these alternative options, please contact our CRA Network Education Representative:  Socorro.Carrasco@anthem.com.

 

Alternative reporting option/Description

Availity Comprehensive Health Assessment Availity will send a notification of members who have gaps and need assessments.  The office will schedule members to be seen, at this time open gaps are displayed.  Once the visit is completed, the office will complete the health assessment via Availity and the provider will review and sign off.  Eligible for $100 incentive.

EPIC Patient Assessment Form (PAF) Providers with EPIC as their EMR system can fax the EPIC PAF to Inovalon at        1-866-682-6680 without a coversheet. Eligible for $50 incentive.

Providers Existing Patient Assessment Form (PAF) -- Utilize providers existing EMR system and applicable PAF and fax to Inovalon at 1-866-682-6680.  Must be submitted with a coversheet indicating "see attached Anthem Progress Note“.  Eligible for $50 incentive.   Note: Please reach out to the CRA Network Education Representative listed above for confirmation that your EMR system’s PAF is compliant.

EPHC Providers using PCMS -- Providers participating in our Enhanced Personal Health Care (EPHC) program can use member reports from our PCMS tool within Availity to schedule members for comprehensive visits.  Providers use normal gap closure through claims submission.  No Health Assessment needed.

List of Members to be scheduled -- Anthem provides member report for Provider to schedule members for comprehensive visits.  Providers use normal gap closure through claims submission.  No Health Assessment needed.

Allscripts Push Notifications (combine with EMR Interoperability for Chart Requests from our Retrospective approach) Once a member is scheduled for visit, provider will get notification of outstanding gaps.  Benefit: Provider is aware upfront, at the time of the visit to address chronic conditions with members and code them accurately on their claim. No Health Assessment needed.

As a contracted provider with Anthem Blue Cross and Blue Shield in Colorado, please remember that you are obligated when medically appropriate to refer Anthem members to in-network providers.  This includes physicians and all provider types including, but not limited to, ambulance transport (ground and air), ambulatory surgical centers, behavioral health services, physical medicine providers and ancillary providers.  Referring to in-network providers allows members to receive the highest level of benefits under their Health Benefit Plan.  As a reminder, call Anthem first for pre-certification if required by the member’s policy. 

 

Ground Ambulance Providers

 

You can search for participating ground providers using our online tool, Provider Finder, located at www.anthem.com. Search parameters include distance from your location (zip code, address or county). To use the tool, go to www.anthem.com and follow these steps in our “Find a Doctor” tool:

 

1. Select “all plans/networks”
2. Select type of coverage
3. I am looking for a : “other medical services”
4. Who specializes in: “ambulance companies”
5. Located near: add your address, zip or county

  

 

 

Air Ambulance Providers

 

The providers listed below are participating air ambulance providers with Anthem in Colorado.  This means that these providers have contractually agreed to accept the Anthem Rate as payment in full for covered services, and they will bill members only for allowable benefit cost-share obligations when transporting members who are picked up in Colorado. 

 

Some air ambulance providers choose not to participate with payers like Anthem. 

• These air ambulance providers may charge members rates that are much higher than the Anthem contracted provider rates.
• Depending on their benefits, members who utilize non-participating air ambulance providers can be left with significant out-of-pocket expenses, which the ambulance providers and their billing agents may seek to collect.

 

To avoid these situations, we ask that, whenever possible, you use a participating air ambulance provider for your patients who are our members.  Utilizing participating providers:  

• Protects the member from balance billing for what may be excessive amounts,
• Assures the most economical use of the member’s benefits, and
• Is consistent with your contractual obligations to refer to in-network providers where available.

 

To schedule fixed wing or rotary wing air ambulance services, please contact Anthem for pre-certification if required by the member’s policy, then call one of the phone numbers listed below. Please have the following information ready when you call:

• Basic medical information about the patient, including the patient’s name and date of birth or age.  If the service was not pre-certified with Anthem, the air ambulance provider will also need to receive a full medical report from the attending facility.
• Current location of the patient, the name of the hospital or facility caring for the patient and its address (city and state).
• Location where patient is to be transported, including the name of the destination hospital/facility and address.
• Approximate transport date or time frame.
• Special equipment or care needs.

 

Should you have questions regarding the air ambulance network, including providers contracted for air ambulance pickups outside of Colorado, please contact your Provider Contract Manager.  To arrange air transport originating outside the U.S., U.S. Virgin Islands and Puerto Rico, call 800-810-BLUE for BCBS Global Core formerly BlueCard Worldwide.

Note:  All Providers listed below service Colorado even if Location Address indicates out of state.

FIXED WING (AIRPLANE) PROVIDERS (HCPCS CODES: A0430 and A0435) 

 

Provider Name	Phone#	Location Address	Web site
Air Ambulance Specialists, Inc. dba AMR Air Ambulance	800-424-7060	8001 S Interport Blvd, #150, Englewood, CO 80112	www.AMRAirAmbulance.com
AeroCare Medical Transport Systems	630-466-0800	43W 752 Hwy 30 Sugar Gove IL 60554	www.aerocare.com
Medway Air Ambulance, Inc.	800-233-0655	570 Briscoe Blvd Lawrenceville, GA 30046	www.medwayair.com
Life Guard International, Inc. dba Flying ICU	702-740-5952	145 E. Reno Avenue Ste. E-7, Las Vegas, NV 89119	www.flyingicu.com

 

ROTARY WING (HELICOPTER) PROVIDERS (HCPCS CODES: A0431 & A0436) 

Provider Name	Phone#	Location Address	Web site
Air Methods (Rocky Mountain/LifeNet/Arch)	909-915-2305	7211 South Peoria, Englewood, CO 80112-4133	www.airmethods.com

 

The Escalation Contact List  has been updated. Access the updated list online. Please go to anthem.com.  Select Providers.  Under the Communications heading, select Contact Us.  Choose Colorado, then select Escalation Contact List.  

Each year, falls result in more than 2.8 million ER visits; 800,000 hospitalizations; and 27,000 deaths. Additional information about helping patients enrolled in Medicare Advantage prevent falls is available online.

 

ABSCRNU-0012-19 March 2019                                    76195MUPENMUB

Anthem Blue Cross and Blue Shield (Anthem) is working with Optum CiOX Health (CiOX) to request medical records for risk adjustment. Risk adjustment is the process by which CMS reimburses Medicare Advantage plans, such as Anthem, based on the health status of their members. Risk adjustment was implemented to pay Medicare Advantage plans more accurately for the predicted health cost expenditures of members by adjusting payments based on demographics (age and gender), as well as health status.  Read the full article here.

 

 

Additional information, including frequently asked questions and answers, will be available at www.anthem.com/ca/medicareprover > Important Medicare Advantage Updates.

 

 

ABSCRNU-0011-19 April 2019                                      76239MUPENMUB

Anthem allows reimbursement for surgery on neonates and infants up to a present body weight of 4 kg when billed with Modifier 63 at 100% of the applicable fee schedule or contracted/negotiated rate. Please note, the neonate weight should be documented clearly in the report for the service.  Read more.

 

 

ABSCRNU-0006-19 March 2019           76050MUPENMUB

Medicare Advantage plans under Anthem Blue Cross and Blue Shield follow original Medicare guidelines and billing requirements for partial hospitalization services. CMS regulations (42 CFR 410.43(c)(1)) state that partial hospitalization programs (PHPs) are intended for members who require a minimum of 20 hours per week of therapeutic services as evidenced in their plan of care. All partial hospitalization services require prior authorization.  Read the full article.

 

 

 

ABSCRNU-0013-19 March 2019                                    76175MUPENMUB

 

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

 

• Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ
• Group Retiree members and National Access Plus
• Prior authorization requirements for DME repair and portable oxygen concentrator
• New provider learning opportunity: Put the AIM ProviderPortal to work for you
• Evaluation and management with Modifier 25 update
• New incentive program for reimbursement for select CPT Category II codes
• Latest updates to Electronic Data Interchange Gateway migration

 

75975MUPENMUB