Advance patient notice reminder

On September 1, 2015, we implemented an Advance Patient Notice (APN) Administrative Policy that requires participating physicians to provide advance written notice to members when they refer those members to non-participating facilities and/or when non-participating providers will be involved in their care. These are situations when there is a high likelihood that the member will not know that he/she will be receiving care in or from a non-participating facility, physician or provider until they receive a bill for the services rendered.

 

This notice is a reminder of the requirement for participating providers to obtain a signed APN Form from members to help ensure their understanding and compliance for a non-participating provider’s service in advance of that service being provided.

 

We will track the use of non-participating facilities, physicians and providers and may request a copy of the APN Form. Other than an occasional administrative error that can occur, failure to provide a copy of the signed APN Form will result in an initial warning from us. Repeated failure to comply with this policy, after initial warning, may result in termination from Anthem’s network(s).

 

Some examples of services that might require an APN include but are not limited to:

 

• In office anesthesiologist - i.e., anesthesia for in-office surgeries or anesthesia provided in connection with surgery or services performed at a free standing surgical center owned in whole or in part by the referring physician
• Surgical assistant (regardless of surgical setting)
• Intraoperative monitoring
• Specialty drug vendor for specialty drugs provided in an office
• In office home infusion therapy (HIT)
• Durable medical equipment orders issued by a physician’s office when the office arranges for the DME delivery from or refers the member to a non-participating DME provider
• Laboratory services for specimens collected in the physician’s office when the specimen is sent to a non-participating reference lab

• Endoscopy suites

• Surgical suites