Moving Toward Equity in Asthma Care
Anthem Blue Cross and Blue Shield is committed to achieving health equity in asthma outcomes with diverse populations. As part of this commitment, we offer an online training, Moving Toward Equity in Asthma Care. This course is accessible from any mobile device or computer and provides one continuing medical education credit at no cost to you. Visit www.mydiversepatients.com.

 Asthma Medication Ratio (AMR) HEDIS^® measure
The National Committee for Quality Assurance (NCQA) is also working to identify and reduce disparities in care. As part of this effort, race and ethnicity stratifications were added to the AMR HEDIS metric this year. The AMR metric measures the percentage of members 5 to 64 years of age who were identified as having persistent asthma and had a ratio of controller medications to total asthma medications of 0.5 or greater during the measurement year.

 Did you know: 

• Hispanics and African Americans with asthma are less likely to take daily controllers and are more likely to visit the ER and be hospitalized for asthma-related conditions than non-Hispanic whites? ¹
• Asian Americans are more likely to die from asthma than non-Hispanic whites?²
• Appropriate medication management for patients with asthma could reduce the need for rescue medication — as well as the costs associated with ER visits, inpatient admissions, and missed days of work or school?

 Helpful tips:  

• Ensure at least half of the medications dispensed to treat asthma are controller medications throughout the measurement period. 
• Talk to the patient about the importance of controller medication compliance, and not to use rescue medications on a regular basis, unless part of asthma action plan.
• Encourage patients to fill their prescriptions on a regular schedule rather than waiting till they are symptomatic.
• Create a written asthma action plan in language the patient understands, and schedule follow-up appointments with patients. Ask patients questions to assess asthma control, adherence to the action plan, and identify
• Utilize evidence-based asthma assessment tools to assess asthma control, adherence to the action plan, and identify triggers.
• Take the Moving Toward Equity in Asthma Care CME course at no cost for more helpful tips.

Additional resources
Also available is the Asthma & Me training. Do your patients have asthma? Show them the pathophysiology of asthma in their preferred language.

References:

1. Asthma and Allergy Foundation of America & National Pharmaceutical Council. (2005). Ethnic Disparities in the Burden and Treatment of Asthma. Retrieved from http://www.aafa.org/media/Ethnic-Disparities-Burden-Treatment-Asthma-Report.pdf
2. U.S. Department of Health & Human Service, Office of Minority Health. (2016, May 9). Asthma and Asian Americans. Retrieved August 8, 2016, from https://www.minorityhealth.hhs.gov
3. Asthma and Allergy Foundation of America. (2020). Asthma Disparities in America: A Roadmap to Reducing Burden on Racial and Ethnic Minorities. Retrieved from: https://aafa.org/wp-content/uploads/2022/08/asthma-disparities-in-america-burden-on-racial-ethnic-minorities.pdf

Anthem will replace our legacy internal provider data management system for Anthem contracted providers in August 2023. Enhancing the overall provider experience, this investment in advanced technology will significantly improve care provider partners’ data accuracy and transparency. New system features strengthen Anthem’s ability to match submitted claims for more accurate pricing and processing.

Critical billing requirements
As part of this system upgrade, Anthem is enforcing the CMS billing guidelines that hold providers accountable for billing claims data correctly. (See CMS Regulations and Guidance.)

Beginning in early 2024, claims submitted with missing or incorrect billing national provider identifier (NPI) will be rejected and mailed back. Submitting claims with complete and correct data is critical to ensure Anthem can process your claims efficiently and accurately. All data fields on claims are used with building your claim records.

You should bill according to standard billing guidelines. As we approach the implementation date for our strategic provider system, we encourage you to review your billing practices carefully to ensure proper tax identification number (TIN), billing national provider identifier (NPI), and rendering provider information (if applicable) are submitted in the appropriate fields. As a reminder, if claims are submitted incorrectly, they will be rejected and mailed back for correction.

Electronic claims filing reminders
If you are filing professional claims electronically (supported by electronic data interchange EDI), below are tips for a successful claim submission:

• Billing provider— Loop (section) 2010:
  • When the billing provider is an organization healthcare provider, the organization’s NPI number is reported in field NM109.
  • The TIN of the billing provider must be reported in the REF segment of this loop.
  • The billing provider may be an individual only when the healthcare provider performing the services is an independent, unincorporated entity.
  • The billing provider address must hold a physical address and should not contain any of the following: Post Office Box, P.O. Box, PO Box, Lock Box, or Lock Bin.
• Rendering provider— Loop 2310:
  • This loop or section of the EDI file is required when the rendering provider’s NPI is different from that carried in Loop ID-2010AA-billing provider. If not required by the EDI implementation guide, do not send.
  • The rendering provider is the person or company who rendered the care.

Mail claims filing reminders
If you are filing a professional claim via mail:

• Facility information:
  • Include the address of the servicing facility — the address where services were rendered — in Box 32.
  • Include the servicing facility’s NPI — service location NPI — in Box 32a.
• Billing provider:
  • The billing provider’s complete name, address, and phone number must be in Box 33.
  • NPI must be reported in Box 33a (group’s organization or individual provider is an independent, unincorporated entity).
  • The TIN of the billing provider must be reported in Box 25.
• Rendering provider:
  • For claims that require a rendering provider, report the rendering provider NPI in Box 24J.

If using a clearinghouse, we suggest that you contact the clearinghouse to ensure proper claims filing and to alert the vendor of Anthem’s upcoming system change. Regular check-ins with your clearinghouse are key to identifying claim issues early.

Critical data requirements
Ensure that all your contracted providers are submitted to Anthem and on file prior to rendering services. This will alleviate any delay in claim processing and ensure the directory reflects correctly. It is a contractual requirement to submit physicians joining your group in a timely manner, prior to the physician rendering care to members.

Going forward
Watch for upcoming editions of Provider News, as we will continue to share information about our progress transitioning to the strategic provider system. We’ll keep you informed in advance of any impacts to our care provider partners.

For more information:

• Colorado – https://www.anthem.com/provider/policies

CMS Regulations and Guidance- https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26pdf.pdf

COBCBS-CRCM-022865-23

Please review your online provider directory information on a regular basis to ensure it is correct. Access your online provider directory information by visiting anthem.com/provider, then under Provider Overview, select Find Care.

Submit updates and corrections to your directory information by using our online Provider Maintenance Form. Online update options include:

• Add/change an address location
• Name change
• Provider leaving a group or a single location
• Phone/fax number changes
• Closing a practice location

Once you submit the form, we will send you an email acknowledging receipt of your request.

The Consolidated Appropriations Act (CAA) implemented in 2021 contains a provision that requires online provider directory information be reviewed and updated as needed at least every 90 days. By reviewing your information regularly, you help us ensure your online provider directory information is current.

We’re committed to being actively involved with our care provider partners and going beyond the contract to create a real impact on the health of our communities. That’s why we offer care providers free continuing medical education (CME) sessions to learn best practices to overcoming barriers in achieving clinical quality goals and improved patient outcomes.

Engagement Hub objectives:

• Learn strategies to help you and your care team improve your performance across a range of clinical areas.
• Apply the knowledge you gain from the webinars to improve your organization’s clinical quality.
• Offer care providers a convenient way to earn CME credits at a time that works best for you.

Register here for our free CME clinical quality webinars!                   

Note: Sessions in this series are approved for one American Academy of Family Physicians credit each.

Join this CME webinar to learn best practices to preventing falls of your older patients Wednesday June 7, 2023.

Skilled Nursing Facility (SNF) providers: Fall prevention and patient safety

For professional claims submitted on a CMS-1500 form processed on or after June 1, 2023, Anthem Blue Cross and Blue Shield will enhance our editing systems to automate edits and simplify remittance messaging. These edit enhancements are supported by correct coding guidelines as documented in industry sources such as Correct Procedural Terminology (CPT^®) guidelines and Centers for Medicare & Medicaid Services (CMS). Additionally, these edit enhancements will promote faster claim processing and reduce follow-up audits and/or record requests for claims that are not consistent with correct coding guidelines. As a result of these edit enhancements, there will be greater attention on identifying inappropriate billing of genetic testing services.

Below are examples of claim edits focused on identifying inappropriate billing of genetic testing services that will be automated:

• Multianalyte Assays with Algorithmic Analyses (MAAA) — CPT 81507: This edit will deny laboratory provider claims submitted with the proprietary laboratory analysis code for the associated proprietary harmony prenatal test when the laboratory provider is not an affiliated proprietary laboratory.
• Panel testing: This edit will deny laboratory provider claims submitted with codes for individual components of a panel test (for example, tumors, inherited conditions, and hematologic malignancy) when a single panel code exists.
  Providers who believe their medical record documentation supports services billed should follow the claims payment dispute process (including submission of all supporting documentation with the dispute) as outlined in the provider manual.

If you have questions on this program, contact your Provider Relationship Account Manager.

Who is affected
For women ages 67 to 85 who sustained a recent fracture, it is important to obtain a bone density scan to assess for osteoporosis.

How can we collaborate?
We can help your patients complete this scan in the comfort of their home through Quest HealthConnect™.*

In home resources
We are working with Quest HealthConnect, a Quest Diagnostics service, to provide this service at no added cost to you. Quest HealthConnect will call your patient to arrange a visit. Patients may also call them directly at 888-306-0615 between 8:30 a.m. to 4 p.m. Eastern Time. The result(s) of the screening test(s) will be sent to both the patient and your office after the visit.

The fax number on the previous communication was incorrect and has been corrected here. The correct fax number is 833-678-0223.

For services beginning on July 1, 2023, prior authorization requests for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services will be reviewed by Carelon Post Acute Solutions, LLC.* The goal of this program is to ensure members receive the right product for the right duration of time in the home. This change will be applicable to the following markets: Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, New Hampshire, Nevada, Ohio, Virginia, and Wisconsin.

How to submit or check a prior authorization request
For DMEPOS services, Carelon Post Acute Solutions will begin receiving requests on Tuesday, June 20, 2023, for dates of service July 1, 2023, and after.  

Providers are encouraged to request authorization using the website. Go here to get started. You can upload clinical information and check the status of your requests through this online tool seven days a week, 24 hours a day. If you are unable to use the link or website, you can call the Carelon Post Acute Solutions Provider Call Center at 844-411-9622 during normal operating hours from 7 a.m. to 7 p.m. CT, Monday through Friday, or send a fax to Carelon Post Acute Solutions at 833-678-0223.

Please note: Carelon Post Acute Solutions will not review authorization requests for products/services that do not fall under Medicare-covered products/services, such as home infusion, hospice, outpatient therapy, or supplemental benefits that help with everyday health and living such as personal home helper services offered under Essential/Everyday Extras.

To learn more about Carelon Post Acute Solutions and upcoming training webinars, visit the website or email.

If you have additional questions, please call the Carelon Post Acute Solutions Provider Call Center at 844-411-9622.

Please continue to check for important Medicare Advantage updates, including:

• Home health, claims payment, and provider network services for Anthem Blue Cross and Blue Shield individual members delegated to Carelon Post Acute Solutions
• Itemized bill review program
• Medical Policies and Clinical Utilization Management Guidelines update