Have you had more patients present with their ID card on their smartphone? We want to remind you of the ways you can access your own copy of their ID card.

 

In the October 2017 issue of Network Update, Anthem (formerly Blue Cross and Blue Shield of Georgia) informed you about our mobile app called Anthem Anywhere that allows members to manage their benefits on their smart phones, including the option of an electronic only version of their ID cards. We want to ensure a member’s electronic only ID card meets your needs. 

 

Based on member requests and growing trends, we anticipate that by the year 2020, nearly 50% of our Local Plan members may choose the electronic ID card option, so we urge you to start using the available retrieval tools today. 

 

Provider options for obtaining a copy of an electronic Member ID card

• Online through the Availity Portal:  Providers also have the option to view Anthem Member ID Cards online (and print if needed) from the Availity Portal at availity.com. When conducting an Eligibility and Benefits (E&B) Inquiry from the E&B Results page, select the blue button titled View Member ID Card. Currently, BlueCard®, Federal Employee Program® (FEP) and some health plans’ Medicare Advantage and Medicaid members are not included.  

Note: as with all E&B Inquiries on Availity, providers must have the member ID number (including the three-character prefix) and one or more search options of date of birth, first name and last name.

 

• Email or Fax:  Members can email/fax the card from his/her phone.  When members are viewing their ID Card on their phone, they will select the email or fax icon to forward their ID card.

These options are available for your patients who are members covered by our affiliated health plans in CA, CO, CT, GA, IN, KY, ME, MO, NH, NV, OH, WI, VA, and NY. 

 

Members are still required to have a copy of their card in one format or another, whether hard copy or electronic, in order for services to be rendered. View our Quick Reference Guide for further details.

 

Quick Reference Guide

See our Electronic Member ID Cards – Quick Reference Guide located on the Answers@Anthem page of our anthem.com/provider website for more details and information on:

• Frequently Asked Questions
• Details on provider options for obtaining a copy of an electronic Member ID card
• Sample electronic Member ID cards

Anthem has identified that providers often bill a duplicate Evaluation and Management (E/M) service on the same day as a procedure even when the same provider (or a provider with the same specialty within the same group TIN) recently billed a service or procedure which included an E/M for the same or similar diagnosis. The use of modifier 25 to support separate payment of this duplicate service is not consistent with correct coding or Anthem’s policy on use of modifier 25. 

 

Beginning with claims processed on or after June 1, 2019 Anthem may deny the E/M service with a modifier 25 billed on the day of a related procedure when there is a recent service or procedure for the same or similar diagnosis on record.

 

If you believe a claim should be reprocessed because there are medical records for related visits that demonstrate an unrelated, significant, and separately identifiable E/M service, please submit those medical records for consideration.

As a contracted provider with Anthem in Georgia, please remember that you are obligated when medically appropriate to refer Anthem members to in-network providers. This includes physicians and all provider types including, but not limited to, ambulance transport (ground and air), ambulatory surgical centers, behavioral health services, physical medicine providers and ancillary providers. Referring to in-network providers allows members to receive the highest level of benefits under their Health Benefit Plan. As a reminder, call Anthem first for prior authorization if required by the member’s policy. 

 

Ground Ambulance Providers

You can search for participating ground providers using our online tool, Provider Finder, located at anthem.com. Search parameters include distance from your location (zip code, address or county). To use the tool, go to anthem.com and follow these steps in our “Find a Doctor” tool:

1. Select “all plans/networks”
2. Select type of coverage
3. I am looking for a : “other medical services”
4. Who specializes in: “ambulance companies”
5. Located near: add your address, zip or county

Air Ambulance Providers

The providers listed below are participating air ambulance providers with Anthem in Georgia. This means that these providers have contractually agreed to accept the Anthem Rate as payment in full for covered services, and they will bill members only for allowable benefit cost-share obligations when transporting members who are picked up in Georgia. 

 

Some air ambulance providers choose not to participate with payers like Anthem. 

• These air ambulance providers may charge members rates that are much higher than the Anthem contracted provider rates.
• Depending on their benefits, members who utilize non-participating air ambulance providers can be left with significant out-of-pocket expenses, which the ambulance providers and their billing agents may seek to collect.

To avoid these situations, we ask that, whenever possible, you use a participating air ambulance provider for your patients who are our members. Utilizing participating providers:  

• Protects the member from balance billing for what may be excessive amounts,
• Assures the most economical use of the member’s benefits, and
• Is consistent with your contractual obligations to refer to in-network providers where available.

To schedule fixed wing or rotary wing air ambulance services, please contact Anthem for prior authorization if required by the member’s policy, then call one of the phone numbers listed below. Please have the following information ready when you call:

• Basic medical information about the patient, including the patient’s name and date of birth or age.  If the service was not prior authorized with Anthem, the air ambulance provider will also need to receive a full medical report from the attending facility.
• Current location of the patient, the name of the hospital or facility caring for the patient and its address (city and state).
• Location where patient is to be transported, including the name of the destination hospital/facility and address.
• Approximate transport date or time frame.
• Special equipment or care needs.

 

Should you have questions regarding the air ambulance network, including providers contracted for air ambulance pickups outside of Georgia, please contact your local network consultant. To arrange air transport originating outside the U.S., U.S. Virgin Islands and Puerto Rico, call 800-810-BLUE for BCBS Global Core formerly Bluecard Worldwide.

FIXED WING (AIRPLANE) PROVIDERS (HCPCS CODES: A0430 and A0435)

Provider Name	Phone#	Location Address	Web site
Air Ambulance Specialists, Inc. dba AMR Air Ambulance	800-424-7060	8001 S Interport Blvd, #150, Englewood, CO 80112	AMRAirAmbulance.com
AeroCare Medical Transport Systems	630-466-0800	43W 752 Hwy 30 Sugar Gove IL 60554	aerocare.com
Central Air Ambulance	866-910-6744	205 Hembree Park, Suite 100, Roswell, GA 30076	centralairambulance.com
Medway Air Ambulance, Inc.	800-233-0655	570 Briscoe Blvd Lawrenceville, GA 30046	medwayair.com
Life Guard International, Inc. dba Flying ICU	702-740-5952	145 E. Reno Avenue Ste. E-7, Las Vegas, NV 89119	flyingicu.com

ROTARY WING (HELICOPTER) PROVIDERS (HCPCS CODES: A0431 & A0436)

Provider Name	Phone#	Location Address	Web site
Air Methods (Rocky Mountain/LIfeNet/Arch)	909-915-2305	7211 South Peoria, Englewood, CO 80112-4133	airmethods.com

 

In a continuation of our CRA reporting update articles throughout 2019, Anthem requests your assistance with respect to our Commercial Risk Adjustment (CRA) reporting processes.

 

As a reminder, there are two approaches that we take, Retrospective and Prospective, to improve risk adjustment reporting accuracy. We are focusing on performing appropriate interventions and chart reviews for patients with undocumented Hierarchical Condition Categories (HCC), to close the documentation and coding gaps that we are seeing with our members enrolled in our Affordable Care Act (ACA) compliant plans.

 

This month we’d like to focus on the Prospective approach, and the request to our Providers.

Anthem network providers, usually primary care physicians, may receive letters from our vendor, Inovalon, requesting that physicians:

1. schedule a comprehensive visit with patients identified to confirm or deny if previously coded or suspected diagnoses exists, and
2. submit a Health Assessment documenting the previously coded or suspected diagnoses (also called a SOAP Note – Subjective, Objective, Assessment and Plan).

Health Assessment requests through Inovalon

We have engaged Inovalon, an independent company that provides secure, clinical documentation services, to help us comply with provisions of the ACA that require us to assess members’ relative health risk level. In the coming weeks and months, Inovalon will be sending letters to providers as part of our risk adjustment cycle, asking for their help with completing health assessments for some of our members.

 

This year will bring a new round of assessments. As a reminder, chronic conditions must be coded every year, and we encourage you to code to the greatest level of specificity on all Anthem claim submissions.  If you have questions about the requests you receive, you can reach Inovalon directly at 866-682-6680.

 

Maximize your Incentive opportunity: submit electronically via Inovalon’s ePASS® tool

Join an ePASS webinar to learn how to submit a Health Assessment electronically and maximize your incentive opportunities. They are offered every Wednesday from 3:00–4:00 p.m. Register by sending an email to ePASSProviderRelations@inovalon.com with your name, organization, contact information and the date of the webinar you wish to attend.

• Teleconference: Dial 1-415-655-0002 (US Toll) and enter access code: 736 436 872  
• WebEx: Visit inovalonmeet.webex.com and enter meeting number: 736 436 872
• Once you join the call, live support is available at any time by dialing *0

 

Alternative reporting engagement

ePASS is our preferred method for submission for the Prospective approach. However to improve engagement and collaborate with our Providers who are not submitting via ePASS, we have identified other alternatives which may be helpful and provide more flexibility with your current processes.

 

If you are interested in any of these alternative options, please email our CRA Network Education Representative, Alicia Estrada at Alicia.Estrada@anthem.com.

 

Alternative reporting option/description:

• Availity comprehensive health assessment: Availity will send a notification of members who have gaps and need assessments. The office will schedule members to be seen, at this time open gaps are displayed. Once the visit is completed, the office will complete the health assessment via Availity and the provider will review and sign off. Eligible for $100 incentive.
• EPIC Patient Assessment Form (PAF): Providers with EPIC as their EMR system can fax the EPIC PAF to Inovalon at 866-682-6680 without a coversheet. Eligible for $50 incentive.
• Providers existing Patient Assessment Form (PAF): Utilize providers existing EMR system and applicable PAF and fax to Inovalon at 866-682-6680. Must be submitted with a coversheet indicating "see attached Anthem progress note“. Eligible for $50 incentive. Note: Please reach out to the CRA Network Education Representative listed above for confirmation that your EMR system’s PAF is compliant.
• EPHC providers using PCMS: Providers participating in our Enhanced Personal Health Care (EPHC) program can use member reports from our PCMS tool within Availity to schedule members for comprehensive visits. Providers use normal gap closure through claims submission. No Health Assessment needed.
• List of members to be scheduled: Anthem provides member report for providers to schedule members for comprehensive visits. Providers use normal gap closure through claims submission. No Health Assessment needed.
• Allscripts push notifications: (combine with EMR Interoperability for Chart Requests from our Retrospective approach) Once a member is scheduled for visit, provider will get notification of outstanding gaps. Benefit: Provider is aware upfront, at the time of the visit to address chronic conditions with members and code them accurately on their claim. No Health Assessment needed.

Effective August 1, 2019, Anthem will upgrade to the 23rd edition of MCG care guidelines for the following modules: Inpatient & Surgical Care (ISC), General Recovery Care (GRC), Chronic Care (CC), Recovery Facility Care (RFC), Behavioral Health Care (BHC).

 

Goal Length of Stay (GLOS) changes for Inpatient & Surgical Care (ISC)

Guideline	MCG Number	23rd Edition GLOS	22nd Edition GLOS
Neurology- Traumatic Brain Injury, Nonsurgical Treatment	M-78	Ambulatory or 2 days	2 days
Orthopedics-Lumbar Fusion	S-820	2 days postoperative	3 days postoperative

New Optimal Recovery Guidelines (ORGs), Common Complications and Conditions (CCC) and Level of Care (LOC) Guidelines

Module	Guideline	Title	MCG Number
ISC	ORG	Anorexia Nervosa, Child or Adolescent	P-585
ISC	ORG	Substance-Related Disorders, Child or Adolescent	P-596
ISC	ORG	Left Atrial Appendage Closure, Percutaneous	M-333
ISC	ORG	Abdominal Pain, Undiagnosed, Pediatric	P-05
ISC	ORG	Craniotomy for Traumatic Brain Injury or Intracerebral Hemorrhage, Pediatric	P-414
ISC	ORG	Craniotomy, Supratentorial, Pediatric	P-411
ISC	ORG	Headaches, Pediatric	P-185
ISC	ORG	Hernia Repair (Non-Hiatal), Pediatric	P-1305
ISC	ORG	Inflammatory Bowel Disease, Pediatric	P-565
ISC	ORG	Pelvic Inflammatory Disease (PID), Acute, Pediatric	P-260
ISC	ORG	Spine, Scoliosis, Posterior Instrumentation, Pediatric	P-1056
ISC	ORG	Supraventricular Arrhythmias, Pediatric	P-510
ISC	CCC	Pain: Common Complications and Conditions	CCC-050
RFC	ORG	Degenerative Joint Disease (DJD)	M-7030
BHC	LOC	Obsessive-Compulsive and Related Disorders, Adult: Inpatient Care	B-030-IP
BHC	LOC	Obsessive-Compulsive and Related Disorders, Child or Adolescent: Inpatient Care	B-029-IP
BHC	LOC	Obsessive-Compulsive and Related Disorders: Residential Care	B-030-RES
BHC	LOC	Obsessive-Compulsive and Related Disorders: Partial Hospital Program	B-030-PHP
BHC	LOC	Obsessive-Compulsive and Related Disorders: Intensive Outpatient Program	B-030-IOP
BHC	LOC	Obsessive-Compulsive and Related Disorders: Acute Outpatient Care	B-030-AOP

 

Anthem customizations to MCG care guideline 23rd edition

Effective August 1, 2019, the following MCG care guideline 23rd edition customizations will be implemented.

• Left Atrial Appendage Closure, Percutaneous (W0157) - customized to refer to SURG.00032 Transcatheter Closure of Patent Foramen Ovale and Left Atrial Appendage for Stroke Prevention
• Spine, Scoliosis, Posterior Instrumentation, Pediatric (W0156) - customized to refer to Musculoskeletal Program Clinical Appropriateness Guidelines, Level of Care Guidelines and Preoperative Admission Guidelines

For questions, please contact the provider service number on the back of the member's ID card.

 

Additional enhancements are now available for Benefit/Service Types in the Availity Portal to better serve you. Now you will be able to access more service types when utilizing the Eligibility and Benefits Inquiry via Availity for many Anthem members.

You may have noticed fairly new additions to Service Types that include:

• Medically Related Transportation
• Long Term Care
• Acupuncture
• Respite Care
• Dermatology
• Sleep Study Therapy (found under Diagnostic Medical)
• Allergy Testing

Although there is an extensive list of available benefit types when submitting an eligibility and benefits request, they vary by payer. Some important points to know about when selecting service type:

• The benefit/service type field is populated with the last benefit type you selected. If you don’t see a specific benefit in the results, submit a new request and select the specific benefit type/service code.
• You have the ability to inquire on 50 patients at one time using the “add multiple patients” feature.

In response to your feedback, we have added additional service types to share even more valuable information with you electronically. So if your practice works with the new service types, now you will be able to view more detailed information on those services electronically. Check them out today.

In the March 2019 edition of our newsletter, we announced the exciting updates we’ve made to the Medical Attachment submission tool. As you start using the updated medical attachment tool on the Availity Portal, you will notice the following changes from the information we shared in March:

• File size – each attachment can be up to 10 MB with a maximum of 30 MB as the file size limit
• The addition of logos in your dashboard make it easy to quickly identify each payer
• The Medical Attachment tool will be retired from the Availity Portal soon, so we encourage you to start utilizing the ‘Attachment – New’ option now. Once a date has been determined for the Medical Attachment Tool retirement we will begin communication.

 

Other features of the updated medical attachment include:

• The ability to submit an itemized bill
• A different link tilted “Attachment – New” where you will now submit medical records when Anthem has requested additional information to process a claim
• A new link on the attachment page called “Send Attachment” will allow you to start the process
• A record history of each entry provides you increased visibility of your submission

 

The Medical Attachment tool makes the process of submitting an electronic documentation in support of a claim, simple and streamlined. You can use your tax identification number (TIN) or your NPI to register and submit solicited (requested by Anthem) medical record attachments through the Availity Portal.

 

NOTE: We will continue to keep you informed of upcoming changes to the ‘Attachment – New’ platform as we progress toward streamlining our electronic documentation functionality.

 

How to access solicited Medical Attachments for your office

Availity Administrator, complete these steps:

 

From My Account Dashboard, select Enrollments Center>Medical Attachments Setup, follow the prompts and complete the following sections:

1. Select Application>choose Medical Attachments Registration
2. Provider Management>Select Organization from the drop-down. Add NPIs and/or Tax IDs (Multiples can be added separated by spaces or semi-colons)
3. Assign user access by checking the box in front of the user’s name. Users may be removed by unchecking their name

 

Using Medical Attachments

Availity user, complete these steps:

1. Log in to availity.com
2. Select Claims and Payments > Attachments-New >Send Attachment Tab
3. Complete all required fields of the form
4. Attach supporting documentation
5. Submit

         

Need Training?

To access additional training for this Availity feature: Log in and select Help & Training | Get Trained to open the Availity Learning Center (ALC) Catalog in a new browser tab. It is your dedicated ALC account. Search the Catalog by keyword (attachments) to find training demo and on-demand courses. Select Enroll to enroll for a course and then go to your Dashboard to access it any time.

Archived Medical Policy and Clinical UM Guideline numbers effective 04-24-2019:

• CG-DRUG-25 Intravenous versus Oral Drug Administration [Note: Content of CG-DRUG-25 has been transferred to new clinical UM guideline CG-MED-82.]
• CG-DRUG-47 Level of Care: Specialty Pharmaceuticals [Note: Content of CG-DRUG-47 has been transferred to new clinical UM guideline CG-MED-83.]

• DRUG.00003 Chelation Therapy [Note: Content of DRUG.00003 has been transferred to new coverage guideline MED.00127.]

• DRUG.00034 Insulin Potentiation Therapy [Note: Content of DRUG.00034 has been transferred to new coverage guideline MED.00128.]

  

Archived Medical Policy Numbers Effective 05-09-2019:

• DRUG.00110 Inotuzumab ozogamicin (Besponsa®) [Note: Content of DRUG.00110 has been transferred to new clinical UM guideline CG-DRUG-113.]
• GENE.00002 Preimplantation Genetic Diagnosis Testing [Note: Content of GENE.00002 has been transferred to clinical UM guideline CG-GENE.06.]  
• GENE.00005 BCR-ABL Mutation Analysis (Qualitative) [Note: Content of GENE.00005 has been transferred to new clinical UM guideline CG-GENE-07.]
• GENE.00031 Genetic Testing for PTEN Hamartoma Tumor Syndrome [Note: Content of GENE.00031 has been transferred to clinical UM guideline CG-GENE-08.]
• GENE.00040 Genetic Testing for CHARGE Syndrome [Note: Content of GENE.00040 has been transferred to new clinical UM guideline CG-GENE-09.]
• MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications [Note: Content of MED.00119 has been transferred to new clinical UM guideline CG-MED-81.]
• RAD.00066 Multiparametric Magnetic Resonance Fusion Imaging Targeted Prostate Biopsy [Note: Content of RAD.00066 has been transferred to new clinical UM guideline CG-SURG.98.]
• SURG.00048 Panniculectomy, Abdominoplasty [Note: Content of SURG.00048 has been transferred to new clinical UM guideline CG-SURG-99.]

 

Archived Medical Policy Number Effective 06-24-2019:

• SURG.00033 Cardioverter-Defibrillators [Note: Content of SURG.00033 has been transferred to new clinical UM guideline CG-SURG-97.]

Anthem allows reimbursement for surgery on neonates and infants up to a present body weight of 4 kg when billed with Modifier 63 at 100% of the applicable fee schedule or contracted/negotiated rate. Please note, the neonate weight should be documented clearly in the report for the service. Read more.

In 2019, Anthem will work with Optum, using their copy partner CiOX, to request medical records with dates of service for the target year 2018, through present day, then review and code the record. Read the full article.

 

Additional information, including frequently asked questions and answers, will be available at anthem.com/medicareprovider under Important Medicare Advantage Updates.

Each year, falls result in more than 2.8 million ER visits; 800,000 hospitalizations; and 27,000 deaths. Additional information about helping patients enrolled in Medicare Advantage prevent falls is available here.

Medicare Advantage plans under Anthem Blue Cross and Blue Shield follow original Medicare guidelines and billing requirements for partial hospitalization services. CMS regulations (42 CFR 410.43(c)(1)) state that partial hospitalization programs (PHPs) are intended for members who require a minimum of 20 hours per week of therapeutic services as evidenced in their plan of care. All partial hospitalization services require prior authorization. Read the full story.

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

• Update: evaluation and management with Modifier 25
• Prior authorization requirements for DME repair and portable oxygen concentrator
• New incentive program for reimbursement for select CPT Category II codes
• Latest updates to Electronic Data Interchange Gateway migration
• Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ
• Group Retiree members and National Access Plus
• New provider learning opportunity: Put the AIM ProviderPortal to work for you