When Anthem Blue Cross and Blue Shield in Connecticut (Anthem) members are admitted to the hospital due to an overdose or a substance abuse disorder (SUD), we receive notice pursuant to our current inpatient notification policies. This notice allows us to engage in discharge planning, including as appropriate, engagement of Anthem behavioral health case managers, to support the member’s transition to appropriate outpatient treatment and promote the member’s short and long-term recovery. In order to provide the same support to members who present to a hospital emergency department for an overdose or SUD but are not admitted to the hospital as an inpatient, we ask that we receive notice from participating hospitals of all emergency department discharges for Anthem members with a diagnosis of overdose or SUD.

 

Procedure:

Currently, hospital emergency rooms triage and assess members presenting with symptoms of an overdose or SUD. When the assessment indicates the need for an inpatient admission, hospitals contact us for prior authorization, which engages the clinical utilization management team. This allows clinical care managers to work with hospitals to identify appropriate aftercare treatment.

 

When an inpatient admission is not indicated and the hospital discharges the member for follow-up outpatient services, our current policies do not require the hospital to notify us. As a result, we are not aware of these encounters and are not able to participate in post discharge planning or care coordination with the member. This inhibits our ability to engage with these members to help support and facilitate their access to appropriate treatment resources to address their substance use issues.

 

Effective August 1, 2020, we will ask that hospitals provide us with notification when an Anthem member presents to the emergency department for an overdose or SUD and is discharged to outpatient services. This notification will allow us to quickly identify members in need of outreach in order to offer them the same type of services that we are able to provide to members who are admitted as an inpatient for the same diagnosis.

 

In order to comply, hospital administrators should complete the notification form and fax notification of the discharge to 877-230-1744 on the same day the patient is discharged from the emergency department. To access this information and the required form on anthem.com, select Providers > Forms and Guides and choose Notification of an Emergency Room Visit for an Overdose

 

Our behavioral health case manager will outreach to the member within three (3) business days of the discharge date to discuss treatment needs and available resources as well as to assess the member for safety and assist the member in accessing care.

 

563-0820-PN-CT



Featured In:
August 2020 Anthem Connecticut Provider News