Contractual obligations for care coordination and case management engagement

As valued providers in our Anthem network, your role is essential in ensuring seamless communication and delivering comprehensive case management for all members.

As part of your contract with Anthem, we ask that you:

• Coordinate care: Facilitate communication between the member's primary care provider (PCP) and other specialists involved in the member’s care to ensure efficient coordination of healthcare services.
• Bidirectionally communicate: Engage in ongoing, two-way communication with Anthem, the member’s PCP, and other specialists involved in the member’s care. Sharing relevant health information, updates, and treatment plans to ensure all parties are informed and aligned in managing the member’s healthcare needs.
• Engage in case management: Actively collaborate with our case managers to develop individualized care plans, assist with appointment scheduling, and coordinate a wide range of healthcare services, ensuring holistic and integrated care for each member.

Importance of care coordination with managed care

Effective care coordination within a managed care framework is essential to improving patient outcomes and operational efficiency. By sharing treatment plans, confirming appointments, and ensuring seamless transitions between different care settings, you can help minimize duplication of services, reduce healthcare costs, and ensure that members receive timely, appropriate care.

Anthem and Carelon Behavioral Health, Inc.

Carelon Behavioral Health, a separate company offering services on behalf of Anthem, specializes in behavioral health services. Carelon Behavioral Health is integrated with Anthem to expand and enhance its behavioral health offerings. As such, you may receive communications from a case manager using a Carelon Behavioral Health email address as a part of the coordinated care efforts to ensure members receive necessary services. Please engage with these associates to improve health outcomes.

We encourage you to revisit and enhance your care coordination processes to ensure compliance with these contractual obligations. Active collaboration with our case managers, along with securing the necessary releases of information, will improve care outcomes and member satisfaction.

Thank you for your dedication and partnership in delivering coordinated, effective care to our members.

Important note: You are not permitted to use or disclose Protected Health Information about individuals who you are not treating or are not enrolled in your practice. This applies to Protected Health Information accessible in any online tool, sent in any medium including mail, email, fax or other electronic transmission.