 Provider News IndianaAugust 2021 Anthem Provider News - Indiana Contents State & Federal | Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging | August 1, 2021 Let’s vaccinateState & Federal | Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging | August 1, 2021 Medicaid News - August 2021
Join us throughout the year in a new Continuing Medical Education (CME) webinar series as we share practices and success stories to overcoming barriers in achieving clinical quality goals, attaining better patient outcomes and improving STARs ratings.
Program objectives:
- Learn strategies to help you and your healthcare team improve your performance across a range of clinical areas.
- Apply the knowledge you gain from the webinars to improve your organization’s quality and STARs ratings.
Attendees will receive one CME credit upon completion of a program evaluation at the conclusion of each webinar.
REGISTER HERE for our upcoming clinical quality webinars
3072F: new language about two-year compliance
The Comprehensive Diabetes Care HEDIS® Measure Retinal Eye Exam (DRE) valuates the percent of adult members ages 18 to 75, with diabetes (type 1 and type 2), who had a retinal eye exam during the measurement year.
Changes to 3072F
The definition for the code 3072F (negative for retinopathy) has been redefined to: Low risk for retinopathy (no evidence of retinopathy in the prior year). This can be particularly confusing because it would not be used at the time of the exam. It would be used the following year, along with the exam coding for the current year, to indicate that retinopathy was not present the previous year.
A simpler coding solution
Using these three codes count toward the DRE measurement if they are billed in the current measurement year, or the prior year. This means you can submit the appropriate code at the time of the exam, and it covers both years:
|
CPT Code
|
Description
|
|
2023F
|
Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy (DM)
|
|
2025F
|
7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed: without evidence of retinopathy (DM)
|
|
2033F
|
Eye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed: without evidence of retinopathy (DM)
|
For more about diabetic retinopathy, visit CMS.gov or use this link to read more.
Meeting the measurement for all diabetes care
These exams are also important in evaluating the overall health of diabetic patients, as well as meeting the Comprehensive Diabetes Care HEDIS measure:
- Hemoglobin A1c (HbA1c) testing
- HbA1c poor control (>9.0%)
- HbA1c control (<8.0%)
- Retinal Eye exam performed
- Blood Pressure control (<140/90 mm Hg)
Record your efforts in the member’s medical records for the HbA1c tests and results, retinal eye exam, blood pressure, urine creatinine test and the estimated glomerular filtration rate test. Meeting the mark and closing gaps in care is key to good health outcomes.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
Reductions in missed appointments are significant
Telehealth visits are having a significant impact on missed appointments according to a study published in Counselling Psychology Quarterly. Prior to transitioning to telehealth, clinicians in the study “Psychotherapy at a public hospital in the time of COVID-19: telehealth and implications for practice,”1 experienced a 14.25% missed appointment rate. After transitioning to telehealth, the missed appointment rate fell to 5.63%.
Rate of missed appointments before and after transitioning to telehealth
The graph below illustrates the changes in the average rate of missed appointments (cancellations and no-show) for each of the eight clinicians in the study between the periods before and after the transition to telehealth.
“While there are a number of limitations to consider regarding this data, [which is further discussed in the study], the statistically significant reduction in missed appointments pre-and-post [digital] transition is striking,” cited in the study report.
Telehealth and telephone visits with members after a behavioral health (BH) inpatient stay meet HEDIS® criteria for the measure: Follow-up after Hospitalization for Mental Illness (FUH). With transportation being one of the barriers to after hospitalization follow-up, telehealth visits could be an ideal solution.2
The FUH HEDIS measure evaluates:
- Members 6 years and older who were hospitalized for treatment of selected mental illness diagnoses and who had a follow-up visit with a mental health practitioner.
Two areas of importance for this HEDIS measure are:
- The percentage of behavioral health inpatient discharges for which the member received follow-up within 7 days after discharge.
- The percentage of behavioral health inpatient discharges for which the member received follow-up within 30 days after discharge.
These two consecutive follow-up appointments are paramount to positive outcomes as well as meeting this HEDIS measure. Telehealth visits can greatly increase the likelihood of keeping follow-up appointments leading to reduced numbers of re-hospitalization and more favorable outcomes for these patients. To learn more about the FUH HEDIS measure, visit the NCQA website.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
We’re making it even easier for you to schedule online appointments through the Appointment Scheduler App on Availity. The Appointment Scheduler App gives you secure access to new appointment requests. You’ll also receive digital access to the member’s ID number, contact information and any special health information.
Appointment Scheduler App features include:
- Manage appointment requests
- Configure appointment availability
- Notifications for new visit requests on your Availity dashboard
- Members are automatically notified by text or email when appointments are confirmed
Administrators, administrator assistants and users with the role of “office staff” will have access to the Appointment Scheduler App.
To access Appointment Scheduler , log onto Availity.com and select Anthem from Payer Spaces. The Appointment Schedule App will be located in your Applications menu. To learn more about the new App, visit the Custom Learning Center in Availity for the Appointment Scheduler Application Reference Guide.
Effective November 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) will transition the clinical criteria for medical necessity review of computed tomography to detect coronary artery calcification to AIM imaging of the heart clinical appropriateness guideline.
As part of this transition of clinical criteria, the following procedures will be subject to prior authorization at AIM:
|
CPT code
|
Description
|
|
75571
|
Computed tomography, heart, without contrast material, with quantitative evaluation of coronary artery calcium
|
|
S8092
|
Electron beam CT (also known as ultrafast CT, cine CT)
|
For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com.
Additionally, you may access and download a copy of the current guideline here.
*Change to Prior Authorization Requirements
Effective November 1, 2021, AIM Specialty Health® (AIM), a separate company, will expand the AIM Musculoskeletal program to perform medical necessity review of the requested site of service for certain spine, joint and interventional pain procedures for Anthem Blue Cross and Blue Shield (Anthem) fully insured members, as further outlined below.
AIM will continue to manage the AIM Musculoskeletal program and Level of Care review. The AIM Level of Care Guideline for Musculoskeletal Surgery and Procedures is used for the Level of Care review. Prior authorization will now also be required for the clinical appropriateness of the site in which the procedure is performed (site of care). AIM will use the following Anthem Clinical UM Guideline: CG-SURG-52: Site of Care: Hospital-Based Ambulatory Surgical Procedures and Endoscopic Services. The clinical criteria to be used for these reviews can be found on the Anthem Provider portal Clinical UM Guidelines page. Please note, this does not apply to procedures performed on an emergent basis.
A subset of the AIM musculoskeletal program codes will be reviewed for site of care. A complete list of CPT codes requiring prior authorization for the AIM Musculoskeletal site of care program is available on the AIM Musculoskeletal microsite. To determine if the AIM Musculoskeletal Program applies to an Anthem member on or after November 1, 2021, providers can contact the Provider Services phone number on the back of the member’s ID card for benefit information. AIM will also have a file upload from Anthem regarding the members to whom the program applies, and will not provide prior authorization for members to whom the program does not apply. If providers use the Interactive Care Reviewer (ICR) tool on the Availity Portal to request prior authorization for a member for the Musculoskeletal Program, ICR will produce a message referring the provider to AIM. Note: ICR cannot accept prior authorization requests for services administered by AIM.
Members included in the new program
All fully insured and administrative services only (ASO) members currently participating in the AIM Musculoskeletal Program are included. For self-funded (ASO) groups that currently do not participate in the AIM Musculoskeletal Program, the Program will be offered to self-funded accounts (ASO) to add to their members’ benefit package as of November 1, 2021.
Prior authorization review requirements
For surgeries that are scheduled to begin on or after November 1, 2021, all providers must contact AIM to obtain prior authorization review
The following groups are excluded: Medicare Advantage, Medicaid, Medicare, Medicare supplement, MA EGR, Federal Employee Program® (FEP®).
For services provided on or after November 1, 2021, ordering and servicing providers may begin contacting AIM beginning October 18, 2021 for review. Providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortallSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
- Access AIM via the Availity Web Portal at availity.com.
- Call the AIM Contact Center toll-free number at 800-554-0580, Monday through Friday, 8:30 a.m. to 7:00 p.m. ET.
Initiating a request on AIM’s ProviderPortalSM for physical, occupational or speech therapy and entering all the requested clinical questions will allow you to receive an immediate determination. If the request is approved, you will receive the Order ID, the number of visits and valid time frame. The AIM Musculoskeletal Program microsite on the AIM provider portal helps you learn more and access helpful information and tools such as order entry checklists.
AIM Musculoskeletal training webinars
Anthem invites you to take advantage of a free informational webinar that will introduce you to the program and the robust capabilities of the AIM ProviderPortalSM. Go to the AIM Musculoskeletal microsite to register for an upcoming webinar. If you have previously registered for other services managed by AIM, there is no need to register again.
We value your participation in our network and look forward to working with you to help improve the health of our members.
*Change to Prior Authorization Requirements
Beginning with dates of service on or after November 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) will update the Related Coding section to indicate no modifier override for the neurostimulator device when billed with the surgical code for the implantation of the neurostimulator device.
The code pairs listed below have been added the below pairs to the Related Coding Section:
- L8680 when reported with 63655
- L8679 when reported with 63650
- L8679 when reported with 63655
- L8687 when reported with 63650
- L8687 when reported with 63655
For more information about this policy, visit the Reimbursement Policy page at anthem.com.
*Change to Prior Authorization Requirements
In our May Provider News, we announced a threshold increase for the itemized bill requirement for outpatient facility claims. This requirement will remain; however effective August 1, 2021, Anthem will remove the threshold amount from the policy language for outpatient facility claims and inpatient stay claims.
For more information about this policy, visit the Reimbursement Policy page at anthem.com.
*Change to Prior Authorization Requirements
Beginning with dates of service on or after November 1, 2021, Anthem Blue Cross and Blue Shield (Anthem)’s current Telehealth policy will be renamed Virtual Visits. Anthem allows reimbursement for professional and facility Virtual Visits when interactive services occur between the member and the provider, when they are not in the same location, unless provider, state, or federal contracts and/or mandates indicate otherwise. Reimbursement is allowed for professional and facility Virtual Visits rendered at the distant site via live audio visual services and for Remote Patient Monitoring. Services reported by a professional provider with a place of service Telehealth (02) will be eligible for non-office place of service reimbursement. In addition, facility Virtual Visits will be allowed for the originating site fee. The Related Coding section details the modifiers allowed for reimbursement.
For more information about this policy, visit the Reimbursement Policy page at anthem.com.
Providers currently submit prior authorization requests to AIM Specialty Health® (AIM) for outpatient diagnostic imaging services. These prior authorizations are often reviewed based on provider attestation of certain requirements. As part of our ongoing quality improvement efforts, we want you to know that some review requests may require documentation to substantiate the attestations that supports the clinical appropriateness of the request. This documentation can be uploaded during the intake process.
When requested, providers must submit such documentation from the patient’s medical record. If medical necessity is not supported through documents submitted, the request may be denied as not medically necessary. Such documentation is limited to what has been asserted via the prior authorization review attestations. If the request would be denied as not medically necessary, providers can participate in a prior authorization discussion with an AIM physician reviewer.
*Change to Prior Authorization Requirements
Effective November 1, 2021, in order to help ensure our member’s security, the Blue Cross and Blue Shield Federal Employee Program (FEP®) will be decommissioning the Utilization Management (UM) email address for processing eReviews, FEPE-Reviews@anthem.com. As an alternative, FEP offers providers a secure online portal, Interactive Care Reviewer (ICR).
About the ICR portal
ICR is Anthem Blue Cross and Blue Shield (Anthem)’s innovative UM portal that allows providers, in addition to phone or fax, to submit prior authorization requests and to provide clinical documentation (including imaging) to support initial and continued stay reviews. This enables prior authorization requests and clinical information to be transmitted directly to UM staff.
Key features of the portal
- No cost electronic UM solution
- Instant access from any location at any time
- Create a UM preauthorization case and instantly submit it for review
- Attach clinical documents for review – no faxing required
- Check status of any case regardless of the method used to originally submit request
- Complete record of submissions and dispositions – all in one place
- Bi-directional communication
To submit prior authorization service requests electronically, register for use of ICR prior to November 1, 2021 on the Availity portal.
For more information on Anthem ICR, including training resources: https://www.anthem.com/provider/prior-authorization/interactive-care-reviewer/
Register for ICR via the Availity portal: https://www.availity.com/provider-portal-registration
Need help registering? View this video: How to Access Availity and Register
As a reminder, in addition to using ICR on the Availity portal, you can submit authorizations, to FEP UM by phone or fax:
- FEP UM precertification toll free #: 800-860-2156
- FEP UM precertification fax #: 800-732-8318
- FEP UM advance benefit determination fax #: 877-606-3807
Visit Pharmacy Information for Providers on anthem.com for more information on:
- Copayment/coinsurance requirements and their applicable drug classes
- Drug lists and changes
- Prior authorization criteria
- Procedures for generic substitution
- Therapeutic interchange
- Step therapy or other management methods subject to prescribing decisions
- Any other requirements, restrictions, or limitations that apply to using certain drugs
The commercial drug list is posted to the web site quarterly (the first of the month for January, April, July and October).
FEP Pharmacy updates and other pharmacy related information may be accessed at www.fepblue.org > Pharmacy Benefits.
Effective with dates of service on or after August 1, 2021, providers treating members covered by Anthem Blue Cross and Blue Shield (Anthem) Commercial plans may be asked to consider voluntarily using adjusted body weight (AdjBW) dosing compared to actual body weight (ABW) dosing for immune globulin medications. The dose change using AdjBW will only be made if the member’s actual body weight is more than 20% of the ideal body weight (IBW).
Since this program is voluntary, the decision to participate will not affect the final decision on the prior authorization.
Reviews for the immune globulin medications will continue to be administered by IngenioRx® as these will specifically target specialty non-oncology indications.
As part of the prior authorization process, providers may be asked the following questions:
- Whether the suggested use of AdjBW and change in dose is clinically acceptable
- Clinical reasoning if the dose change (using AdjBW) is not appropriate
Providers can view prior authorization requirements for Anthem members on the Medical Policy & Clinical UM Guidelines page at anthem.com.
Providers should continue to verify eligibility and benefits for all members prior to rendering services.
If you have questions, please call the Provider Service phone number on the back of the member’s ID card.
Effective with dates of service on or after August 1, 2021, providers treating members covered by Anthem Blue Cross and Blue Shield (Anthem) Commercial plans may be asked to consider voluntarily reducing the requested dose to avoid vial wastage for select non-oncology specialty medications. The dose reduction suggestion will only be made if the originally requested dose is within 10% of the nearest whole vial.
Since this program is voluntary, the decision to participate will not affect the final decision on the prior authorization.
Reviews for these specialty drugs will continue to be administered by IngenioRx®.
As part of the prior authorization process, providers may be asked the following questions:
- Whether the suggested dose reduction is clinically acceptable
- Clinical reasoning if the dose reduction is not appropriate
Providers can view prior authorization requirements for Anthem members on the Medical Policy & Clinical UM Guidelines page at anthem.com.
Providers should continue to verify eligibility and benefits for all members prior to rendering services.
If you have questions, please call the Provider Service phone number on the back of the member’s ID card.
Providers treating members covered by Anthem Blue Cross and Blue Shield (Anthem) plans will be asked in selective circumstances to voluntarily reduce the requested dose to the nearest whole vial for over 40 oncology medications (see list below). Reviews for these oncology drugs will continue to be administered by AIM Specialty Health ® (AIM).
As part of the online prior authorization process, providers will be asked about the dosage of the medication being requested in pop-up questions:
- Whether or not the recommended dose reduction is acceptable
- If the patient is considered unable to have his or her dose reduced, then a second question will appear asking for the provider’s clinical reasoning.
For prior authorization requests made outside of the online AIM Provider Portal (i.e. via phone or fax) the same questions will be asked by the registered nurse or medical director reviewing the request. Since this program is voluntary, the decision made regarding dose reduction will not affect the final decision on the prior authorization.
The dose reduction questions will appear only if the originally requested dose is within 10 percent of the nearest whole vial. This threshold is based on the current medical literature and recommendations from the Hematology and Oncology Pharmacists Association (HOPA) it is appropriate to consider dose rounding within 10 percent. Click here to view the HOPA recommendations.
The voluntary dose reduction program only applies to the specific oncology drugs listed below. Providers can view prior authorization requirements for Anthem members on the Medical Policy & Clinical UM Guidelines page at anthem.com.
Note: In some plans “dose reduction to nearest whole vial” or another term “waste reduction” may be the term used in benefit plans, provider contracts or other materials instead of or in addition to “dose reduction to nearest whole vial” and in some plans, these terms may be used interchangeably. For simplicity, we will hereafter use “dose reduction (to nearest whole vial).”
Providers should continue to verify eligibility and benefits for all members prior to rendering services.
If you have questions, please call the Provider Service phone number on the back of the member’s ID card.
|
Drug Name
|
HCPCS Code
|
|
Abraxane (paclitaxel protein-bound)
|
J9264
|
|
Actimmune (interferon gamma-1B)
|
J9216
|
|
Adcetris (brentuximab vedotin)
|
J9042
|
|
Alimta (pemetrexed)
|
J9305
|
|
Asparlas (calaspargase pegol-mknl)
|
J9118
|
|
Avastin (bevacizumab)
|
J9035
|
|
Bendeka (bendamustine)
|
J9034
|
|
Besponsa (inotuzumab ozogamicin)
|
J9229
|
|
Blincyto (blinatumomab)
|
J9039
|
|
Cyramza (ramucirumab)
|
J9308
|
|
Darzalex (daratumumab)
|
J9145
|
|
Doxorubicin liposomal
|
Q2050
|
|
Elzonris (tagraxofusp-erzs)
|
J9269
|
|
Empliciti (elotuzumab)
|
J9176
|
|
Enhertu (fam-trastuzumab deruxtecan-nxki)
|
J9358
|
|
Erbitux (cetuximab)
|
J9055
|
|
Erwinase (asparginase)
|
J9019
|
|
Ethyol (amifostine)
|
J0207
|
|
Granix (tbo-filgrastim)
|
J1447
|
|
Halaven (eribulin mesylate)
|
J9179
|
|
Herceptin (trastuzumab)
|
J9355
|
|
Herzuma (trastuzumab-pkrb)
|
Q5113
|
|
Imfinzi (durvalumab)
|
J9173
|
|
Istodax (romidepsin)
|
J9315
|
|
Ixempra (ixabepilone)
|
J9207
|
|
Jevtana (cabazitaxel)
|
J9043
|
|
Kadcyla (ado-trastuzumab emtansine)
|
J9354
|
|
Kanjinti (trastuzumab-anns)
|
Q5117
|
|
Keytruda (pembrolizumab)
|
J9271
|
|
Kyprolis (carfilzomib)
|
J9047
|
|
Lumoxiti (moxetumomab pasudotox-tdfk)
|
J9313
|
|
Mvasi (bevacizumab-awwb)
|
Q5107
|
|
Mylotarg (gemtuzumab ozogamicin)
|
J9203
|
|
Neupogen (filgrastim)
|
J1442
|
|
Ogivri (trastuzumab-dkst)
|
Q5114
|
|
Oncaspar (pegaspargase)
|
J9266
|
|
Ontruzant (trastuzumab-dttb)
|
Q5112
|
|
Opdivo (nivolumab)
|
J9299
|
|
Padcev (enfortumab vedotin-ejfv)
|
J9177
|
|
Polivy (polatuzumab vedotin-piiq)
|
J9309
|
|
Riabni (rituximab-arrx)
|
Q5123
|
|
Rituxan (rituximab)
|
J9312
|
|
Ruxience (rituximab-pvvr)
|
Q5119
|
|
Sarclisa (isatuximab-irfc)
|
J9227
|
|
Sylvant (siltuximab)
|
J2860
|
|
Trazimera (trastuzumab-qyyp)
|
Q5116
|
|
Treanda (bendamustine)
|
J9033
|
|
Truxima (rituximab-abbs)
|
Q5115
|
|
Vectibix (panitumumab)
|
J9303
|
|
Yervoy (ipilimumab)
|
J9228
|
|
Zaltrap (ziv-aflibercept)
|
J9400
|
|
Zirabev (bevacizumab-bvzr)
|
Q5118
|
*Change to Prior Authorization Requirements
Prior authorization updates
Effective for dates of service on and after November 1, 2021, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our prior authorization review process.
Please note, inclusion of National Drug Code (NDC) code on your claim will help expedite claim processing of drugs billed with a Not Otherwise Classified (NOC) code.
Access the Clinical Criteria information here.
Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by the medical specialty drug review team. Review of specialty pharmacy drugs for oncology use is managed by AIM Specialty Health® (AIM).
|
Clinical Criteria
|
HCPCS or CPT Code(s)
|
Drug
|
|
**ING-CC-0196
|
J3490
J9999
J3590
|
Zynlonta
|
|
**ING-CC-0197
|
J3490
J3590
J9999
|
Jemperli
|
|
*ING-CC-0199
|
J3490
J3590
C9399
|
Empaveli
|
* Non-oncology use is managed by the medical specialty drug review team.
** Oncology use is managed by AIM.
Quantity limit updates
Effective for dates of service on and after November 1, 2021, the following specialty pharmacy codes from current or new clinical criteria documents will be included in our quantity limit review process.
Please note, inclusion of National Drug Code (NDC) code on your claim will help expedite claim processing of drugs billed with a Not Otherwise Classified (NOC) code.
Access the Clinical Criteria information here.
Prior authorization clinical review of non-oncology use of specialty pharmacy drugs is managed by the medical specialty drug review team. Review of specialty pharmacy drugs for oncology use is managed by AIM Specialty Health® (AIM).
|
Clinical Criteria
|
HCPCS or CPT Code(s)
|
Drug
|
|
*ING-CC-0199
|
J3490
J3590
C9399
|
Empaveli
|
* Non-oncology use is managed by the medical specialty drug review team.
** Oncology use is managed by AIM.
*Change to Prior Authorization Requirements
Effective with dates of service on and after October 1, 2021, and in accordance with the IngenioRx Pharmacy and Therapeutics (P&T) process, Anthem will update its drug lists that support commercial health plans.
Updates include changes to drug tiers and the removal of medications from the formulary.
Please note, this update does not apply to the Select Drug List and does not impact Medicaid and Medicare plans.
To ensure a smooth member transition and minimize costs, providers should review these changes and consider prescribing a drug on formulary or on a lower tier, if appropriate.
View a summary of changes here.
Know best: Shingles vaccinations are a Medicare Part D benefit whether administered in your office or in the pharmacy
We want you to have the information you need when filing claims for our Medicare Advantage members so your payments are received quickly and effortlessly. The shingles vaccine and the administration of the vaccine is commonly billed in error under the member’s Medicare Part B medical benefit. The shingles vaccination is a Medicare Part D pharmacy benefit, which requires the member to pay in advance of reimbursement. The member then submits the prescription drug claim form to their Medicare Part D plan for reimbursement.
You can also refer the member to the pharmacy for the vaccine. The claim is usually filed for the member by the pharmacy provider using a clearinghouse platform that enables Medicare Part D claims transactions. Or, if you have access to clearinghouse platforms that enable you to file pharmacy transactions, that is another option for administering the vaccination in your office and for further serving the member.
The Centers for Medicare & Medicaid Services (CMS) has a helpful resource, MLN Fact Sheet: Medicare Part D Vaccines, that offers an all-inclusive look into patient access, vaccine administration, and reimbursement. Use this link to download a copy.
We want you to have all the information you need to know best. For more information about filing claims, visit this link.
This communication applies to the Medicaid and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem).
CMS issued an Interoperability and Patient Access Policy to reduce the burden of certain administrative processes. The CMS policy requires providers to implement application programming interfaces (APIs) to improve the electronic exchange of healthcare data between patient, provider and payer. The policy reiterates that in partnership with the Office of the National Coordinator for Health Information (ONC), CMS identified Health Level 7® (HL7) as the foundational standard to support data exchange via secure API. Implementation of this CMS mandate is expected by July 1, 2021.
The Clinical Data Acquisition Group for Anthem integrates admission, discharge and transfer (ADT) data from facility providers, health information exchanges and third-party aggregators. ADT data exchange helps Anthem:
- Better support members with care coordination and discharge planning — leading to healthier outcomes for our members, your patients.
- Proactively manage care transitions to avoid waste.
- Close care gaps and educate members about appropriate care settings.
Anthem would like to digitally exchange HL7 ADT messaging data for our members using secure data collection and transmission capabilities currently in use by facility systems. Facilities with network connections through vendors or health information exchanges can integrate ADT data with Anthem through these channels as well. Near real-time HL7 ADT messaging data — or at least within 24 hours of admission, discharge or transfer — enables Anthem to most effectively manage care transitions.
Email the Clinical Data and Analytics team at ADT_Intake@Anthem.com to get started today.
State & Federal | Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging | August 1, 2021 Resources to support your diverse patient panelAs patient panels grow more diverse and needs become more complex, providers and office staff need more support to help address patients’ needs. Anthem Blue Cross and Blue Shield (Anthem) wants to help.
Cultural competency resources
Here is an overview of the cultural competency resources available on our provider website.
- Cultural Competency and Patient Engagement includes:
- The impact of culture and cultural competency on healthcare.
- A cultural competency continuum, which can help providers assess their level of cultural competency.
- Disability competency and information on the Americans with Disabilities Act (ADA).
- Caring for Diverse Populations Toolkit includes:
- Comprehensive information, tools and resources to support enhanced care for diverse patients and mitigate barriers.
- Materials that can be printed and made available for patients in provider offices.
- Regulations and standards for cultural and linguistic services.
- My Diverse Patients offers:
- A comprehensive repository of resources to providers to help support the needs of diverse patients and address disparities.
- Courses with free continuing education credit through the American Academy of Family Physicians.
- Free accessibility from any device (for example, desktop computer, laptop, phone or tablet), no account or login required.
To access these resources, go to providers.anthem.com/in > Resources > Training Academy > Cultural Competency Resources > Caring for Diverse Populations.
In addition, providers can access Stronger Together, which offers free resources to support the diverse health needs of all people where they live, learn, work and play. These resources were created by our parent company in collaboration with national organizations and are available for you to share with your patients and communities.
Prevalent non-English languages (based on population data)
Like you, Anthem wants to effectively serve the needs of diverse patients. It’s important for us all to be aware of the cultural and linguistic needs of our communities, so we are sharing recent data about the prevalent
non-English languages spoken by 5% or 1,000 individuals in Indiana.1
Prevalent non-English languages in Indiana: Spanish
Language support services
As a reminder, Anthem provides language assistance services for our members with limited English proficiency (LEP) or hearing, speech, or visual impairments. Please see the provider manual for details on what is available and how to access resources. In addition, the cultural competency resources shared above provide guidance on communicating and serving diverse populations effectively.
State & Federal | Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging | August 1, 2021 What Matters Most: Improving the Patient ExperienceWhat Matters Most: Improving the Patient Experience is an online course for providers and office staff that addresses gaps in care and offers approaches to communication with patients. This course is available at no cost and is eligible for one CME credit by the American Academy of Family Physicians.
The What Matters Most training can be accessed at patientexptraining.com.
State & Federal | Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging | August 1, 2021 Attention facilities: Sending admission, discharge and transfer data to Anthem results in improved care management for patientsThis communication applies to the Medicaid and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem).
CMS issued an Interoperability and Patient Access Policy to reduce the burden of certain administrative processes. The CMS policy requires providers to implement application programming interfaces (APIs) to improve the electronic exchange of healthcare data between patient, provider and payer. The policy reiterates that in partnership with the Office of the National Coordinator for Health Information (ONC), CMS identified Health Level 7® (HL7) as the foundational standard to support data exchange via secure API. Implementation of this CMS mandate is expected by July 1, 2021.
The Clinical Data Acquisition Group for Anthem integrates admission, discharge and transfer (ADT) data from facility providers, health information exchanges and third-party aggregators. ADT data exchange helps Anthem:
- Better support members with care coordination and discharge planning — leading to healthier outcomes for our members, your patients.
- Proactively manage care transitions to avoid waste.
- Close care gaps and educate members about appropriate care settings.
Anthem would like to digitally exchange HL7 ADT messaging data for our members using secure data collection and transmission capabilities currently in use by facility systems. Facilities with network connections through vendors or health information exchanges can integrate ADT data with Anthem through these channels as well. Near real-time HL7 ADT messaging data — or at least within 24 hours of admission, discharge or transfer — enables Anthem to most effectively manage care transitions.
Email the Clinical Data and Analytics team at ADT_Intake@Anthem.com to get started today.
State & Federal | Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging | August 1, 2021 Let’s vaccinateHelp increase your vaccination rates and close gaps-in-care with these tools and strategies
Healthcare providers are seen as trusted sources of medical information and are in a unique position to improve lives and community health. Research shows that a strong vaccination recommendation from a provider is the greatest motivator for people of all ages to vaccinate themselves and their family members against serious infectious diseases.
Let’s Vaccinate offers providers tools and strategies to aid in vaccinating people of all ages. This website will help your practice:
- Address disparities for vaccine-preventable diseases.
- Identify and fill workflow gaps, including assessing vaccination status, enhancing vaccine, communications, providing vaccine education, and improving vaccine management and administration in your office.
- Connect with your state immunization program, local immunization coalition, or other vaccine advocates in your community to collaborate.
Keeping all patients healthy and safe requires the support and collaboration of the entire healthcare industry. So, together, let’s vaccinate.
Let’s Vaccinate is a collaboration of Anthem, Inc., Pfizer Inc., and Vaccinate Your Family.
State & Federal | Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for Aging | August 1, 2021 Medicaid News - August 2021 |