 Provider News ColoradoNovember 2022 Anthem Provider News - ColoradoAs a partner in the care of our members, we ask that you review your online provider directory information regularly and provide updates as needed.
For any needed changes, please update your information by submitting them to us on our online Provider Maintenance Form. Once you submit the form, you will receive an email acknowledging receipt of your request.
Online update options include:
- Add/change an address location
- Name change
- Tax ID changes
- Provider leaving a group or a single location
- Phone/fax number changes
- Closing a practice location
The Consolidated Appropriations Act (CAA), effective January 1, 2022, contains a provision that requires online provider directory information be reviewed and updated (if needed) at least every 90 days. Thank you for doing your part in keeping our provider directories current.
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).
2022 Subject Specific Webinars – November schedule
|
Topic:
|
Requests for Additional Information (RFAI) Program
|
|
Date/Time:
|
Wednesday, November 30, 2022, from 12:00-1:00pm MT
|
|
Description:
|
Learn how to receive digital notifications through Availity for requests for additional information.
- Anthem receives a claim, but additional documentation is needed to process the claim. The claim is pended.
- Anthem pushes a notice to the provider’s Attachment Dashboard Inbox (on Availity.com) requesting the additional documentation to process the claim. The notice remains in the Inbox until we have received the requested information or for up to 30 calendar days.
- Providers log onto Availtiy.com, to access their Inbox from their Attachment Dashboard. They identify their claim and submits the requested attachment right there from their Dashboard Inbox.
Join us to learn how to register your organization for this new process.
|
|
Registration link:
|
https://attend.webex.com/attend/onstage/g.php?PRID=cacb2b7aea26c3b21dbfd40d46017c97
|
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.
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.
This communication applies to the Commercial and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem).
HEDIS medical record submission made easier with our remote EMR access service
Let us take on the responsibility to retrieve medical records for the annual HEDIS® hybrid project by signing up for the remote electronic medical record (EMR) access service offered Anthem.
We offer providers the ability to grant access to their EMR system directly to pull the required documentation to aid your office in reaching compliance while reducing the time and costs associated with medical record retrieval.
We have a centralized EMR team experienced with multiple EMR systems and extensively trained annually on HIPAA, EMR systems, and HEDIS measure updates. We complete medical record retrieval based on minimum necessary guidelines:
- We only access medical records of members pulled into the HEDIS sample using specific demographic data.
- We only retrieve the medical records that have claims evidence related to the HEDIS measures.
- We access the least amount of information needed for use, disclosure, or for the specific medical records request.
- We only save to file and do not physically print any PHI.
Getting started with remote EMR access
Download and complete the registration form, then email it to us at: Centralized_EMR_Team@anthem.com.
FAQ
How does Anthem retrieve your medical records?
We access your EMRs using a secure portal and retrieve only the necessary documentation by printing to an electronic file we store internally on our secure network drives.
Is printing access necessary?
Yes. The NCQA audit requires print-to-file access.
Is this process secure?
Yes. We only use secure internal resources to access your EMR systems. All retrieved records are stored on Anthem secure network drives.
Why does Anthem need full access to the entire medical record?
There are several reasons we need to look at the entire medical record of a member:
- HEDIS measures can include up to a 10-year look back at a member’s information.
- Medical record data for HEDIS compliance may come from several different areas of the EMR system, including labs, radiology, surgeries, inpatient stays, outpatient visits, and case management.
- Compliant data may be documented or housed in a nonstandard format, such as an in‑office lab slip scanned into miscellaneous documents.
What information do I need to submit to use the remote EMR access service?
Complete the registration form that requests the following information:
- Practice/facility demographic information (for example, address, NPI, TIN, etc.)
- EMR system information (for example, type of EMR system, required access forms, access type, etc.)
- List of current providers/locations or a website for accessing this list
Remote Access not an option? We are now offering onsite visits for HEDIS hybrid retrieval. Email us at Centralized_EMR_Team@anthem.com for more information.
We’re phasing in clear, concise, and simplified denial descriptions when returning claims status inquiries. The denial descriptions will explain why the claim or claim line was denied and what to do next. We’ve even included details about how to provide us with information digitally to move the claim further along in the claims process.
Continuing to improve
The new denial descriptions will be phased in over the next few months. Based on your feedback, we’re starting with those claims or claim lines that have caused the most confusion. If new denial reasons are added, the descriptions will be expanded as well.
Accessing claim statuses
The Claims Status application on availity.com* enables you to check the status of your claim and submit attachments needed to process your claim, all in one place. To access the Claims Status app, log into availity.com and, from the Claims & Payments tab, select Claims Status. It’s just that fast and easy to check your claim status through Availity Essentials.
If you’re not enrolled in Availity Essentials, use this link for registration information: https://availity.com/Essentials-Portal-Registration. There is no cost for our providers to use the applications through Availity Essentials.
Working together to streamline processes through technology is a collaborative effort. We appreciate your feedback as we continue improving to meet your expectations. The enhancements we’ve made to the Availity Essentials* Authorization application make it faster, easier, and more efficient to submit digital authorizations for Anthem Blue Cross and Blue Shield members.
View attachments for authorizations submitted — You can now view the attachments you’ve submitted to support your authorization in the Availity Essentials authorization application.
Servicing and rendering provider — We’ve enhanced the Availity Essentials Authorization Application to enable a group option when selecting the servicing and rendering provider.
View correspondence — Access status and decision letters right from the Authorization Application Dashboard. Letters can also be downloaded or printed if needed.
Enhanced provider status — Out-of-network and in-network provider statuses are now enhanced to return fewer errors associated with provider status.
Expanded search — Search rendering and serving provider by NPI and ZIP code for quicker results.
Procedure code enhancement — Add the procedure code on an outpatient authorization for more accurate submission.
Case update features — You can now update your authorization right from your Authorization Application Dashboard.
Training sessions on the Availity Essentials authorization application are still available
Whether you prefer live training webcasts, on-demand webinar recordings, or a resource guide, we have everything you need to learn more about the Availity Essentials Authorization Application and how to make the most of it. Use this link to access the training option best for you.
The next live webcast is Wednesday, November 9, 2022, at 11 a.m. ET. Register here.
When submitting claims through the Electronic Data Interchange (EDI), a PWK segment indicator tells us you will be submitting supporting documentation for the claim and ensures the documents are attached correctly. The supporting documents are then sent through the Availity Essentials* Attachments Dashboard.
In November, the Attachments Dashboard will have a new look for Anthem Blue Cross and Blue Shield claims
The sooner we receive your claim attachments, the faster your claim can be processed for payment. To meet this expectation, the Attachments Dashboard will begin a seven-calendar day countdown beginning in November. This means that claims will begin processing sooner for those claims with the PWK segment indicator.
If you are unable to meet the seven-calendar day submission deadline, the claim will move from your Attachments Dashboard inbox into your History folder and will be marked as expired. The claim will then deny for additional information based on the PWK segment indicator and move to Claims Status located under the Claims & Payments tab on availity.com. Upload your attachment from Claims Status by using the Submit Attachment button located on your claim.
To learn more about the new claims attachments workflow, visit our Provider Learning Hub or access the on-demand webinar recording, Learn about the new claims attachments workflow, using this link.
We incorrectly published this article in the November 2022 issue of Provider News. The digital dispute function is not currently available in Colorado on Availity.com.
Submitting Anthem Blue Cross and Blue Shield claims disputes through Availity Essentials* is the most efficient way to have a claim reconsidered. Easily accessible through the Claims & Payments application, select Claims Status to access the claim. Use the Dispute button to file the appeal and upload supporting document to finalize the submission.
Add multiple claims to one dispute submission
You can submit one dispute and add multiple claims — up to 25 claims — as long as the additional disputed claims are for the same member, provider, and dispute reason. For Commercial member claims, you can begin submitting multiple claims on one dispute beginning in November.
Access acknowledgement, update, and decision letters digitally, too
Access correspondence related to your disputes through the Appeals Dashboard. When you submit multiple claims on one dispute through Availity Essentials, you will receive correspondence related to each individual dispute, so expect a greater number of letters in your Appeals Dashboard. You can easily identify the correspondence related to your multiple dispute submission by looking for the
CI-COMM case number.
Availity Essentials appeals training
For detailed instructions about submitting disputes electronically, use this link to access appeals training from Availity Essentials.
New learnings added to the Provider Learning Hub.
Remittance Inquiry App: How to view, print, and save remittance advice
If you’re still using paper remittance to reconcile your claims, imagine the time you’ll save when you access remittance advice digitally through availity.com. This course shares information about how to view, print, and save electronic remittances.
Attachments: How to setup the Medical Attachment role
To submit attachments digitally (medical records, itemized bills, or other documents needed to process your claims), registering your organization in this training is step one. It will help you every step of the way.
Claim Submission: How to submit a claim using direct data entry
For providers who are not submitting their claims through Electronic Data Interchange (EDI), availity.com offers direct data entry for professional and facility claims. Take this course and walk through the process for submitting claims electronically.
Get started today
Access the Provider Learning Hub today using this link or from anthem.com under Important Announcements on the home page.
- All courses and webcasts are available 24/7 for your convenience.
- Use filtering options to quickly find courses and job aids.
- Use the Favorites folder to save items for easy access later.
- Once registered, no further registration is required.
- On future visits, your preferences are populated eliminating the need for any additional logon information.
Not registered on availity.com? Use this link for registration information or access registration information from the Provider Learning Hub. There is no cost for our providers to use availity.com.
This is a reminder for you to refer Anthem members to participating labs whenever possible. Referring Anthem members to a nonparticipating lab may expose them to a greater financial responsibility. LabCorp* is our preferred lab provider and is a single-source solution for your testing requirements. LabCorp referrals do not affect network hospital-based lab service providers, contracted pathologists, or contracted independent laboratories. Physicians can continue to refer to all participating lab providers as they have in the past. In your Anthem Agreement you agreed to refer Anthem members to participating labs when available. This is important because members will only receive their full benefits from participating lab providers. As a reminder, Quest Diagnostics* is a nonparticipating laboratory for all lines of business in Colorado. There are certain nonparticipating labs offering to waive or cap co-payments, coinsurance, or deductibles for our members. These practices undermine member benefits and represent questionable billing practices. Referring to LabCorp assures our members their lab costs will be covered under their benefit terms.
For a listing of Anthem participating laboratories, please check our online directory. Go to https://www.anthem.com, select For Providers, and select Go To Providers Overview. From here, select Find Resources in Your State, and choose Colorado. From the Provider Home tab, select the enter button from the blue box on the right side of page titled Find Care. 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 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:- Allergy program
- Cancer testing
- Cardiovascular disease
- Companion diagnostics
- Dermatology
- Diabetes
- DNA testing
- Endocrine disorders
- Esoteric coagulation
- Gastroenterology
- Genetic testing
- Genetic counseling
- Genomics
- HLA lab for National Marrow Donor Program
- Hematopathology
- Infectious disease
- Immunology
| - Liver disease
- Kidney disease
- Medical drug monitoring
- Molecular diagnostics
- Newborn screening
- Pain management
- Pathology expertise with range of subspecialties
- Pharmacogenomics
- Preimplantation genetic diagnosis
- Reproductive health
- Obstetrics/gynecology
- Oncology
- Toxicology
- Whole exome sequencing
- Virology
- Women’s health
- Urology
|
To find a LabCorp location near you, go to https://www.labcorp.com or call one of the phone numbers below. For information about specialized assays or about requirements for special collection kits and specimen handling, call LabCorp at 303-792-2600 or toll free at 888-LABCORP (888-522-2677). * LabCorp and Quest Diagnostics are independent companies providing laboratory services on behalf Anthem Blue Cross and Blue Shield. Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. COBCBS-CRCM-005940-22-SRS5940, COBCBS-CRCM-049184-24 As you may be aware, the U.S. Preventive Services Task Force (USPSTF) issued updated guidelines recommending screening for colorectal cancer to begin at age 45.1 The USPSTF considers highly sensitive fecal occult blood tests (FOBT) as a good option for colorectal cancer screening. The FDA has approved fecal immunohistochemical testing (FIT also known as iFOBT) for colorectal cancer screening in average risk patients. When FIT is performed at the recommended intervals, it has similar specificity and sensitivity to stool-based DNA tests.
Labcorp* is our preferred lab provider and has a cost-effective colorectal cancer screening option that provides high sensitivity and specificity while enabling patient ease, convenience, and satisfaction. You can improve patient compliance for colorectal cancer screening with Labcorp’s fecal immunohistochemical testing (FIT) kit. Labcorp’s FIT kit provides your patients with everything they need to complete the sample collection at home and mail it back to Labcorp. In addition, the kit is easy to use, requiring no special preparation or direct stool contact.
When you use Labcorp you’ll have:
- Electronic delivery of results to your electronic medical records (EMR) system, making documentation of screening results easier for you and your office staff.
- Patient friendly in-home collections.
- 99.1% sensitivity and 100% specificity2, resulting in a high-quality test.
For more information
To obtain FIT kits for your office or for more information, contact your local Labcorp sales representative. You can also visit www.labcorp.com/cancer/colorectal/providers for additional ordering details.
This communication applies to the Commercial and Medicare Advantage programs from Anthem Blue Cross and Blue Shield (Anthem) in Colorado.
Effective November 6, 2022, Anthem will transition the Clinical Criteria for medical necessity review of perirectal hydrogel spacer to the AIM Specialty Health®* (AIM) Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline.
As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortalSM directly at https://providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
- Access AIM via Availity* at availity.com.
For questions related to guidelines, contact AIM via email at aim.guidelines@aimspecialtyhealth.com.
Additionally, you may access and download a copy of the current and upcoming guidelines here.
Effective for dates of service on and after December 1, 2022, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.
Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.
|
HCPCS or CPT® codes
|
Medicare Part B drugs
|
|
C9399, J3490, J3590, J9999
|
Opdualag (nivolumab and relatlimab-rmbw)
|
|
C9096
|
Releuko (filgrastim-ayow)
|
|
A9699
|
Pluvicto (lutetium lu 177 vipivotide tetraxetan)
|
|