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).

2021 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'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.

1111-0521-PN-CO

This is a reminder to ensure that you are referring Anthem Blue Cross and Blue Shield (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 in order 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 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 is capable of providing 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.

1103-0521-PN-CO

The Appointment Scheduler application in Availity Payer Spaces is an online appointment-scheduling feature that allows providers to manage appointments with patients that may want to schedule appointments directly. Providers can manage patients’ appointment requests and maintain their appointment availability.

Providers can receive new appointment requests from active members, along with important information like the member’s ID number, contact information and any special health information they want the doctor to know. Providers can modify or deactivate their availability at any time. Availity Users with the role of “Office Staff” can set up physicians in the practice to accept online appointment requests.

Enrollment for Appointment Scheduler is easy. To access Appointment Scheduler in the Availity portal: Availity > Payer Tile > Applications > Appointment Scheduler.

Appointment Scheduler Features:

• Manage appointment requests and view physician availability
• Configure appointment availability
• Notification of new visit requests on Availity Notification Center and via email
• Members are notified directly via text or email once appointment is confirmed
• Send patient reminders via the Appointment Scheduler application
• Customize office locations and available times, as well as the types of appointments accepted

Visit the Appointment Scheduler application in the Availity portal today.





1120-0521-PN-CO

Announcement - Provider bulletins for medical attachments and itemized bill attachments



Our organization is working robustly to establish Anthem Blue Cross and Blue Shield (Anthem) as a digital-first enterprise and to streamline your daily working tasks by using electronic functionalities. In support of the Digital-First Solutions we are excited to publish two Provider Bulletins about submitting medical attachments and itemized bills in partnership with Availity.

The objective of the bulletins is to provide a simple guide for you and your staff with step-by-step navigation instructions, where to find help and training with medical attachments.

The provider bulletins are posted on the Availity Poral:  Availity > Payer Tile > Applications >Custom Learning Center (CLC).  Under the Resources tab,select either Provider Bulletin Medical Attachment or Provider Bulletin Medical Attachment – Itemized Bill to access and download.

Please encourage your staff who have questions on the process or who are not submitting claim attachments electronically to review these valuable resources for assistance.

1139-0521-PN-CO

All associates who make utilization management decisions are required to adhere to the following principles:

• Utilization management decision making is based only on appropriateness of care and service and existence of coverage.
• We do not specifically reward practitioners or other individuals for issuing denials of coverage or care. Decisions about hiring, promoting or terminating practitioners or other staff are not based on the likelihood or perceived likelihood that they support, or tend to support denials of benefits.
• Financial incentives for utilization management decision makers do not encourage decisions that result in underutilization or create barriers to care and service.

The American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child care. Known as the “periodicity schedule,” this screenings and assessments guideline provides a comprehensive schedule for each well-child visit, from infancy.

Schedule for well-child visits

The AAP recommends that children should have a total of eight visits before their 30-month birthday (six visits before they are 15 months) with annual visits thereafter. The AAP periodicity schedule aligns with the well-child visits in the first 30 months of life (W30) HEDIS® measure.  Ensuring all visits are completed before the child’s 30-month birthday is critical to assuring compliance with these measures. 

Complete coverage for well-child visits regardless of when visit is received

Well-child visits (WCV) are covered 100% regardless of when the visit is received. Payment is not dependent on a set schedule, so there is no requirement to wait for a milestone birth month to schedule the well-child visit.

HEDIS® measures W30 and WCV

• Well-child visits in the first 30 months of life (W30)
  Description: The percentage of members who had the following number of well-child visits with a PCP during the last 15 months. The following rates are reported:
• Well-child visits in the first 15 months. Children who turned 15 months old during the measurement year: six or more well-child visits.
• Well-child visits for age 15 month to 30 months. Children who turned 30 months old during the measurement year: two or more well-child visits.
• Child and adolescent well-care visits (WCV)
  Description: The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

1133-0521-PN-CO

In honor of National High Blood Pressure education month, learn more about CDC’s WISEWOMAN program: Well-Integrated Screening and Evaluation for Women Across the Nation. The aim of this program is to improve the delivery of heart disease and stroke prevention services for underserved women, aged 40-64 years. The program focuses on cardiovascular disease risk factors, specifically improving high blood pressure.¹ To learn even more about WISEWOMAN, visit the CDC website.

Resources for your patients

If your patient is one of the tens of millions of American adults who have hypertension, you know encouraging a healthier lifestyle and prescribing the right medications is important to managing the condition. But, if you would like to provide additional information about high blood pressure to your patients, take advantage of the helpful resources available to healthcare professionals through the CDC. The Hypertension Communications Kit provides blood pressure logs, tip sheets, and more. hypertension patient education handouts include fact sheets, medication information and dozens of useful tools.

Meeting the HEDIS® measure?

Controlling high blood pressure (CBP) assesses adults ages 18-35 with a diagnosis of hypertension and whose blood pressure was properly controlled base on the following criteria.

• Adults 18-59 years of age whose blood pressure was <140/90 mm Hg
• Adults 60-85 years of age, with a diagnosis of diabetes, whose blood pressure was <140/90 mm Hg
• Adults 60-85 years of age, without a diagnosis of diabetes, whose blood pressure was <150/90 mm Hg

Patient claims should include one systolic reading and one diastolic reading.²

¹https://www.cdc.gov/wisewoman/about.htm

²https://www.cdc.gov/bloodpressure/index.htm

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

1134-0521-PN-CA

We’ve heard it all our lives: To be fair, you should treat everybody the same. But the challenge is that everybody is not the same—and these differences can lead to critical disparities not only in how patients access health care, but their outcomes as well.  The current health crisis illuminates this quite clearly.  It is imperative to offer care that is tailored to the unique needs of patients, and Anthem Blue Cross and Blue Shield (Anthem) is committed to supporting our providers in this effort. 

MyDiversePatients.com offers education resources to help you support the needs of your diverse patients and address disparities, including:

• Free Continuing Medical Education (CME) learning experiences about disparities, potential contributing factors and opportunities for providers to enhance care.
• Real life stories about diverse patients and the unique challenges they face.
• Tips and techniques for working with diverse patients to promote improvement in health outcomes.

Stronger Together offers free resources to support the diverse health needs of all people where they live, learn, work and play. These resources were created by our parent company in collaboration with national organizations and are available for you to share with your patients and communities.

While there is no single easy answer to the issue of health care disparities, the vision of MyDiversePatients.com and Stronger Together is to start reversing these trends…one person at a time.

Embrace the knowledge, skills, ideals, strategies, and techniques to accelerate your journey to becoming your patients’ trusted health care partner by visiting these resources today.

My Diverse Patients


Stronger Together Health Equity Resources



1132-0521-PN-CO

After receiving your feedback, we expanded our server to meet your need to upload larger files to our digital attachment tool, through Availity. You can now upload files up to 100 megabytes, eliminating the need to mail or fax.

Use the attachment tool to upload:

• Medical records
• Itemized bills
• Payment dispute
• EOB
• General correspondence
• Consent forms

The digital attachment tool file size expansion is just one example of how Anthem Blue Cross and Blue Shield is using digital technology to improve the healthcare experience, with a goal to save you valuable time.

Access the attachment tool through availity.com. From the Claims & Payments header, select Attachments – New. For more information about how to setup electronic attachments, use the Getting Started Guide: Select Help & Training >Find Help and then the Attachments topic in Contents. Once logged on you can also access the Getting Started Guide using this link.

For information about setting up for Program Integrity attachments, once logged on to Availity, use this link. You can also access Program Integrity attachment information from the Custom Learning Center: Payer Spaces  > Custom Learning Center > Electronic Medical Records.

1140-0521-PN-CO

Often, health-care cost incurred by Anthem Blue Cross and Blue Shield (Anthem). Members are result of recommendations made by their physicians. As an Anthem participating physician, you have the ability to help reduce your patients’ health-care costs. Choices, such as where to refer a member for negative pressure wound therapy, can have a significant impact on your patients’ ultimate out-of-pocket liability. We are sharing the following information with you for consideration when referring patients for Negative Pressure Wound therapy.

Our members, your patients, often participate in health benefit plans that may have coinsurance or deductibles. Your patients may experience significant differences in cost depending on which negative pressure wound therapy providers the members are referred to. The following table provides a sample listing of Anthem high quality, low cost national negative pressure wound therapy providers. Referring to these providers will likely lower your patients’ out-of-pocket costs.

You can find all of Anthem’s participating durable medical equipment (DME) orthotics and prosthetics providers, at “Find Care” – Anthem’s doctor finder and transparency tool at www.anthem.com.

Anthem is committed to seeking ways to reduce health care costs, and your referrals to network participating providers can help make a difference. We appreciate your partnership in considering the financial impact to your patients – our members, especially during these challenging economic times.

If you have questions, please contact your local Network Relations Consultant or call Provider Services.

1141-0521-PN-CO

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).

2021 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'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.

1111-0521-PN-CO

To more appropriately align program intention to support member care coordination and to ensure compliance with regulatory requirements surrounding the program, Anthem Blue Cross and Blue Shield (Anthem) is amending the approach for enhanced reimbursement that accompanies selection of ‘on-pathway’ chemotherapy drug regimens as part of the AIM Oncology/Cancer Care Quality Program (AIM/CCQP). 

Effective July 1, 2021, enhanced reimbursements for medical oncologists selecting on-pathway drug regimens as part of the AIM/CCQP chemotherapy authorization process will be adjusted for specific regimens.  

Impacted regimens include only select oral and hormonal agents for which a monthly in-office visit may not be required. For these impacted regimens, the optional enhanced reimbursement award, billable using S-codes for treatment planning and care coordination management for cancer, will be reduced from a monthly award during each month of treatment to a single award to accompany treatment initiation (S0353).  

This will impact all authorizations submitted through the AIM authorization process on or after July 1, 2021, regardless of planned treatment dates. 

AIM and Anthem will continuously review the regimen library to ensure S-code award levels remain consistent with program goals regarding care coordination support. 

For a list of the specific regimens that will be impacted by these changes, to view open the worksheet.

Contact your Anthem network representative or your oncology provider engagement liaison for more information. 

1118-0521-PN-CO

Identifying the most appropriate COVID-19 testing codes, testing sites and type of test to use can be confusing. The guidance below can make it easier for you to refer your patients to high-quality, lower-cost COVID-19 testing sites, Anthem Blue Cross and Blue Shield (Anthem) contracted laboratories and identify the proper CPT^® codes to use. Contact your Anthem representative for additional information or visit anthem.com/medicareprovider.  

Refer patients to anthem.com to find convenient testing locations

If an Anthem member requests a COVID-19 test, you may refer them to Anthem to find a testing location near them. Our test-site finder gives members important information about each site, including days and hours of operation, and if they offer:

• Appointment or walk-in
• Drive through service
• Rapid test results
• Antibody testing
• Testing for children

Consider Antigen testing as an option when rapid results are needed

Antigen tests can be a quicker way to detect COVID-19 than nucleic acid amplification tests (NAAT), (for example, PCR). Antigen tests offer a reasonable and lower cost alternative when screening asymptomatic or low-risk patients and may be most useful for individuals within the first five to seven days of symptoms when virus replication is at its highest.

Send swab tests to Anthem-contracted laboratories

When providing COVID-19 molecular testing services to our members, consider utilizing the following additional in-network, high-quality labs to assist in helping to ensure that our members are receiving high-value healthcare.

517852MUPENMUB

Learn more information about Anthem Blue Cross and Blue Shield Working with Optum to Collect Medical Records for Medicare Risk Adjustment.

517674MUPENMUB

Learn how we are helping our senior members.

517505MUPENMUB

Learn more information about the updates to the AIM Specialty Health Musculoskeletal Program Clinical Appropriateness Guidelines.

517808MUPENMUB