We’ve been conducting our in-person Provider Seminars throughout the state in October.  In case you’ve missed any of them, or just if you prefer a webinar option, we still have opportunities for you to participate. 

 

• 1 remaining in-person session Friday, November 2, 2018 -- registration for this sessions closes November 1 at 5:00pm MT
• 4 webinar sessions throughout November

 

Please join us for one of these sessions. They include important updates and information about doing business with us. Topics include: Product overview for 2019, Affordable Care Act updates for 2019, Medicare Advantage PPO, CU Exclusive updates, WellChoice overview, New Provider newsletter/communication template, Anthem.com Provider website enhancements, Availity Portal enhancements, plus more!

 

NOTE: The content covered in the Provider Seminars and Webinars is the same, but we split the webinars into two content parts to make the online learning experience a little easier and shorter length. 

 

For locations and dates, see attached Provider Seminar Invitation.

 

The online registration includes automated acknowledgement of your registration, an appointment to add to your calendar, and reminder notifications.  Don’t forget to accept the calendar appointment to add it to you calendar. 

 

Register online using one of the following options:    

Go to anthem.com. Select Providers, then Providers Overview.  Select Find Resources for Your State, and pick Colorado.  From the Provider Home page, under the Communications and Updates heading, select the Provider Seminars link.  Next, under the Fall 2018 Provider Seminars heading, select the link titled Fall 2018 Provider Seminar Invitation -- online registration form, select either IN-PERSON or WEBINARS.

We are pleased to share that Paul Marchetti has been named Senior Vice President, Network and Care Delivery Transformation for Anthem. Paul joined Anthem October 22 and will have responsibility for Anthem’s overall care transformation strategy.

 

Paul is a respected leader who has more than 25 years of payer and provider experience in healthcare delivery systems, business operations, product development and population health, and technology solutions. Paul joins Anthem from New Century Health, a specialty care management company, where he served as Chief Growth Officer and led top-line revenue growth, strategic planning and execution and product development. Prior to his current role, Paul held leadership roles at Aetna, United HealthCare, Horizon Healthcare and Physicians Health Services.

 

Paul looks forward to meeting and engaging with our healthcare professionals and payers to evolve the healthcare system to one that is simpler, more accessible and more affordable for all Americans.

Effective October 14, 2018, Anthem Blue Cross and Blue Shield (Anthem) will enforce the requirement to bill the correct modifier and HCPCS for services utilized.  Incorrect billing will be rejected and claims will be returned to the provider for correction and resubmittal.

 

Durable Medical Equipment (DME) may be purchased, rented or rented until the purchase price has been paid. 

 

Correct billing will allow member benefits to be applied correctly to include benefit accumulations for a member’s DME benefits.

The Prefix Reference List has been updated. Access the updated list online. Please go to anthem.com.  Select Provider, and Providers Overview. Select Find Resources for Your State, and pick Colorado.  From the Provider Home page, under the Self Service and Support heading, choose Contact Us (Escalation Contact List & Alpha Prefix List), and then Prefix Reference List.

The Prefix Reference List has been updated. Access the updated list online. Please go to anthem.com.  Select Menu, and under the Support heading, select Providers.  Select Find Resources for Your State, and pick Colorado.  From the Provider Home page, under the Self Service and Support heading, choose Contact Us (Escalation Contact List & Alpha Prefix List), and then Escalation Contact List.

We invite you to go to anthem.com to learn about the many ways health care reform and health insurance marketplace / affordable care act information may impact you. New information is added regularly. To view the latest articles on health care reform and/or health insurance marketplace / affordable care act, and all achieved articles, go to anthem.com. Select Providers, and Providers Overview. Select Find Resources in Your State, and pick Colorado.  Select the Provider Home tab at the top of the page.  Under the Communications and Updates heading, choose Health Care Reform Updates and Notifications or Health Insurance Exchange Marketplace / Affordable Care Act information.

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

 

• Prior authorization requirements for Part B drugs: Moxetumomab Pasudotox, Cemiplimab and Fulphila
• July Medicare Advantage reimbursement policy
• Submit PA medication requests electronically; new phone number for MA prescription PAs
• CMS issues regulatory changes for short- and long-acting narcotics; days’ supply limits effective January 1, 2019
• Inpatient Readmissions
• Submit PA medication requests electronically; new phone number for MA prescription prior authorizations effective September 1
• Introducing the Interactive Care Reviewer

Every year, somewhere between five and twenty percent of the population contract the flu. Last year’s flu season was one of the worst in recent memory, and some experts are predicting that this year will follow the same pattern. 

 

Anthem Blue Cross and Blue Shield (Anthem) is trying to help members locate alternatives to Emergency Rooms for care that does not require an Emergency Room setting.  Frequently the services these patients need are not emergent and sometimes not even urgent. 

As flu season approaches, we are trying to help you know alternatives available for your Anthem patients when they are unable to see their Primary Care Provider or other treating provider.

 

Urgent Care Centers and ER Alternatives

 

Anthem’s provider directories currently include Urgent Care centers, Retail Health Clinics, and Walk-in Doctor’s Offices. 

 

If it's not an emergency and the member can't get to his/her regular doctor, he/she may be able to get the care needed -- and save time and money with these other types of quick-care options.

• Urgent Care Centersare staffed with family, pediatric, ER and internal medicine doctors. They treat certain conditions right away that are not as severe as emergencies.
• Retail Health Clinicsare often found in a major pharmacy or retail store. They have physician assistants and nurse practitioners onsite to treat basic health concerns.
• Walk-in Doctors' Officesare usually family practice doctors who can treat many things even if the member is not a regular patient or have an appointment.

 

Members should always call 911 or go the Emergency Room (ER) if he/she thinks they are having a real emergency or if the member thinks it could put their health at serious risk by delaying care.

 

Access our online Provider Directory at https://www.anthem.com/find-doctor/.

 

DispatchHealth - Denver and Colorado Springs only

 

While we encourage members to utilize urgent care centers as lower cost options to an Emergency Room (ER) visit when appropriate, we’re also offering our Anthem network providers a convenient solution to the ER alternatives listed above.  This new option may be especially helpful for members that may have issues leaving home. 

 

DispatchHealth travels so the flu doesn’t. They bring high-quality care to your patients’ homes when acute needs arise after hours or during busy clinic days, and their board-certified medical teams will fully document your patients’ visits and send detailed clinical notes directly to you.

 

For cases of the flu, their medical team -- also referred to as this season’s “Traveling Flu Crew” -- will arrive ready to perform a rapid infectious disease test, administer IV fluids, prescribe anti-nausea medication, prescribe antivirals if caught early enough, and order a chest x-ray if pneumonia is suspected.

 

Each DispatchHealth medical team consists of either a physician assistant or nurse practitioner, along with a medical technician and on-call physician. There’s no added cost to your practice. 

 

DispatchHealth will bill Anthem directly for the care provided, just like an urgent care. A visit with DispatchHealth typically costs 80-90 percent less than the average emergency room visit.

 

You can refer a patient to DispatchHealth when you’re on-call, after hours and on weekends and holidays. Your patients can also request care from DispatchHealth directly by simply calling 720-588-9686.

 

To learn more, visit dispatchhealth.com.

The Centers for Medicare & Medicaid Services has increased its emphasis on the appropriate use of statins among Medicare Advantage (MA) beneficiaries diagnosed with diabetes and cardiovascular disease. Please evaluate whether your patients with diabetes and/or cardiovascular disease would be appropriate candidates for statin therapy.

 

The 2013 American College of Cardiology and the American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults supports the use of moderate-intensity statin therapy in persons with diabetes 40 to 75 years of age to reduce the risks of atherosclerotic cardiovascular disease (ASCVD) events. High-intensity statin therapy is recommended if the patient has an estimated 10-year ASCVD risk ≥7.5 percent. For males 21-75 and females 40-75 years of age with clinical ASCVD, high-intensity statin therapy is recommended unless contraindicated.  These guidelines recommend statin therapy in these scenarios regardless of the patient’s LDL values.  Please evaluate if your patients with diabetes and/or cardiovascular disease would be appropriate candidates for statin therapy.

 

Formulary agents are listed below:

 

Therapy intensity	Drug (brand)	Dose
Moderate-intensity statin therapy (formulary agents)	atorvastatin**	10 mg, 20 mg
	rosuvastatin*	5 mg, 10 mg
	simvastatin**	20 mg, 30 mg, 40 mg
	pravastatin**	40 mg, 80 mg
	lovastatin**	40 mg
High-intensity statin therapy (formulary agents)	atorvastatin**	40 mg, 80 mg
	rosuvastatin*	20 mg, 40 mg

 

*Rosuvastatin (Crestor) is a preferred brand medication on the Medicare formulary. 

 

**Available for a $0 co-pay for most plans in 2018