Delegation of functions under Anthem Medicare Advantage Plans effective July 1, 2018

We have entered in to a collaborative partnership for certain Anthem Medicare Advantage plans with OptumCare® Network of Connecticut (OptumCare IPA). This partnership includes our CareMore at-home program and our delegation of certain administrative functions for members who select or are assigned an OptumCare IPA primary care provider (PCP). 

 

Our delegation of administrative services shall apply to the following Anthem MediBlueSM plans:

 

• Anthem MediBlue Plus HMO
• Anthem MediBlue Dual Advantage (SNP)
• MediBlue Select (HMO)

Members who have selected a PCP who is part of the OptumCare IPA will be issued new identification cards to reflect the updated information outlined below.

 

Please note this delegation does not apply to members who select/are assigned PCPs outside of the OptumCare IPA.

 

Providers who have questions about participation in the OptumCare IPA should call the OptumCare Network Development Department at 860-284-5326.

 

Effective July 1, 2018, the OptumCare IPA will assume the following administrative functions for Anthem MediBlue Plus HMO, Anthem MediBlue Dual Advantage (SNP), and MediBlue Select (HMO) members who have selected an OptumCare IPA PCP. All other services, including claims processing will be retained by Anthem.

 

Pre-certification Requests

• Providers should contact OptumCare for pre-certifications. Requests can be submitted to OptumCare electronically through their online portal at https://provider.optumcare.com. (If you do not yet have access, please call OptumCare Network Development at 860-284-5326 to receive log-in information.)
• Pre-certification requests may also be submitted by calling 888-556-7048 or by faxing requests to 855- 268-2904.
• For your convenience, the Anthem Medicare Advantage Precertification Requirements can be accessed here.

Medical Management

• To obtain prior authorization, please call the provider number listed on the back of the member’s identification card 888-556-7048.

Credentialing Process

• Non-OptumCare IPA providers: Providers who are not contracted with the OptumCare IPA must continue to follow the Anthem credentialing process.
• OptumCare IPA providers: OptumCare will handle all credentialing for its participating providers, including submission of any demographic changes or terminations.

If you have any questions, please contact our Medicare Provider Services Unit at 866-673-4157.

 

72748CTSENABS 06/15/18