As the New Year approaches, remember to request ID cards from your patients and update your records.  Many Anthem Blue Cross and Blue Shield members are receiving new ID cards with new group numbers and new ID numbers effective January 1. 2022.

 

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Parents may not understand the importance of taking their children to the doctor when they are healthy. The benefits are documented by the American Academy of Pediatrics¹ as well as the Centers for Disease Control and Prevention² and it all starts with a recommendation by you, the trusted physician. Share these benefits with parents during regularly scheduled well-visits, or even during sick visits, to reinforce the importance of staying on track:

• Prevention. Regular wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.
• Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.
• Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.
• Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.

 

Measure up: Well-Child Visits in the first 30 months of life (W30)

This HEDIS_® measure is described as the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months. These rates are reported:

• Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.
• Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.

 

Tips

• Telehealth visits are acceptable in meeting the measurement requirements.
• Consider scheduling well-child visits in advance of the child reaching the age for the visit.

 

Coding

• ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2
• HCPCS: G0438-G0439, S0302
• CPT: 99381-99382, 99391-99392, 99461

 

¹Parent Plus: Importance of routine pediatrician visits. American Academy of Pediatrics. https://publications.aap.org/aapnews/news/12481?autologincheck=redirected

²Catch up on well-child visits and recommended vaccinations. Centers for Disease Control and prevention. cdc.gov/vaccines/parents/visit/vaccination-during-COVID-19.html 

 

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Blue High Performance Network plans offer access to providers with a record of delivering high-quality, efficient care. BlueHPN^® networks first went live January 1, 2021 in more than 50 cities across the country, including in the Indianapolis, South Bend, Fort Wayne and Evansville metro areas. Even more members are enrolled in plans with access to our high performance network for 2022.

 

Member ID cards and other plan material will feature one small change for 2022: BlueHPN is now a single word rather than two.

 

As a reminder, BlueHPN is a national network designed from our local market expertise, deep data and strong provider relationships, and aligned with local networks across the country. These local networks are connected to the national chassis to form a national BlueHPN network.

 

In Indiana, Anthem offers large and small group employers plans with access to the BlueHPN network, with the existing HealthSync network as the Indiana HPN entry.

 

Use the Find Care / Find a Doctor tool at anthem.com to check for participation in the BlueHPN network.

 

As was the case in 2021, you may see patients accessing the Blue HPN/Blue Preferred Network through HMO or HSA plans with an HMO network. Under these plans, out of network benefits are limited to emergency or urgent care. Members must select a primary care provider, but PCP referrals are not required for specialty care.

 

Some members will have a 3 Tier plan. Treatment from a Tier 1 HealthSync Provider is at their highest level of benefit. Tier 2 Benefits cover providers participating in our PPO network. Providers participating in our PPO network will be reimbursed at their PPO rate and the member will have a higher out of pocket costs than seeing a Tier 1 provider. Tier 3 covers providers that are out of network with the member having the greatest out of pocket.

 

Large group Blue HPN health plans sold in Indiana have a plan prefix of H8I; small group plans sold in Indiana have a prefix of H9I, and MEWA plans sold in Indiana will have a prefix of H6I. Keep in mind that other prefixes may be part of HPN plan member IDs. The sample ID card below is for a fictional member from Indiana enrolled in a plan with an “H9I” prefix. The new “Blue High Performance Network” logo and “BlueHPN” indicator in the suitcase icon are the most reliable indicators that a member is enrolled in an HPN plan.

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Please continue to check Provider Communications & Updates on the provider webpage for the latest information, including:

 

• Durable medical equipment prior authorization requirement changes effective January 1, 2022

 

We have enhanced your ability to search, review, and download a copy of the remittance advice on Availity* when there is not an associated payment. For remit advice with payment, you can continue to search with the Check/EFT number.

 

Below are images reflecting the scenarios that have been enhanced:

 

Paper remittance

Electronic remittance advice (ERA/835)

What has changed?

1. Non-payment number display in the Check Number and Check/EFT Number fields:
   • Old — There were two sets of numbers for the same remittance advice. The paper remittance displayed 10 bytes (9999999999 or 99########) and the corresponding 835 (ERA) displayed 27 bytes (9999999999 — [year] #############).
   • Enhancement — The updated numbering sequence for the paper remittance and corresponding 835 (ERA) now contain the same 10-digit number beginning with 9 (9XXXXXXXXX). Each non-payment remittance issued will be assigned a unique number.

 

2. Searching for non-payment remittance:
   • Old — When using Remit Inquiry to locate paper remittance, the search field required a date range and tax ID to locate a specific remittance due to same number scenario (10 bytes (9999999999) being used for every non-payment remittance.
   • Enhancement — Once the unique ERA non-payment remittance number is available, it can be entered in the check number field in Remit Inquiry. This new way of assigning check numbers provides a faster and simplified process to find the specific remittance.

 

The way your organization receives remittances and payments has not changed; we have simply enhanced the numbering for the non-pay remittances. These changes do not impact previously issued non-payment remittance advice.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

 

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The Cancer Care Navigator (CCN) program is a comprehensive cancer support solution for oncologists and Anthem Blue Cross and Blue Shield (Anthem) members who are at high risk for complications during treatment. This program is aimed at helping to simplify the complexities of cancer care for members.

 

Practices are given a single point of contact to connect the practice to the right people at Anthem to help lessen administrative burdens. CCN also gives the practice access to Anthem’s advanced predictive analytics to help identify patients at high risk for complications, in turn allowing providers the opportunity to take preventive action and guide targeted interventions.

 

Patients are provided with a wealth of support through supplemental services (dietitians, pharmacists, etc.), medication adherence assistance, individualized care plans and goal setting, as well as after-hours telephonic and digital support.

 

CCN is the ultimate support service to improve the care experience and quality of life to allow patients time to focus on overall health and well-being. Please feel free to reach out to the CCN team at 866-649-0669.

 

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Please continue to read news and updates at anthem.com/medicareprovider for the latest Medicare Advantage information, including:

 

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines update
  
  
• Medical step therapy updates
  
  
• Anthem expands specialty pharmacy precertification list

Effective January 1, 2022, IngenioRx/CVS Specialty Pharmacy* will no longer distribute the brand name drug Botox_®. However, Botox will still be available to Anthem Blue Cross and Blue Shield (Anthem) members through other vendors.

 

Please note:

• This is not a change in member benefits. This is a change in the Botox vendor only.
• If the member is not using IngenioRx/CVS Specialty Pharmacy to obtain Botox, no action is needed.

 

For Botox managed under a Medicare member’s part B (medical) benefit

Providers should be using buy and bill for any Medicare member who currently receive Botox through their part B (medical) benefit.  If your patient is receiving Botox using their part B benefit and is receiving their prescription from IngenioRx/CVS Specialty pharmacy, effective January 1, 2022, IngenioRx/CVS Specialty will no longer filled the prescription. As of January 1, 2022, you will need to buy this drug and bill your patient’s health plan.

 

If you have questions regarding a Medicare member’s part B benefits, call Provider Services using the information on the back of the member’s ID card.

 

For Botox managed under a Medicare member’s part D (pharmacy) benefit

Effective January 1, 2022, Medicare members who currently receive Botox through IngenioRx/CVS Specialty Pharmacy using their part D (pharmacy) benefit must change to another in-network specialty or retail pharmacy that can obtain and dispense Botox.

 

If you have questions regarding a Medicare member’s part D benefit, call Pharmacy Member Services using the information on the back of the member’s ID card.

 

* IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem Blue Cross and Blue Shield. CVS is an independent company providing pharmacy services on behalf of Anthem Blue Cross and Blue Shield.

 

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The HEDIS® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care services. 

 

The ECDS Reporting Standard provides a method to collect, and report structured electronic clinical data for HEDIS quality measurement and improvement. 

 

Benefits to providers:

• Reduced burden of medical record review for quality reporting
• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

 

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

 

Learn more about NCQA’s digital quality system and what it means to you and your practice, at the following link: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

 

ECDS measures

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure.  In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

 

For HEDIS measurement year 2022, the following measures can be reported using ECDS: 

• Childhood Immunization Status (CIS-E)*
• Immunizations for Adolescents (IMA-E)*
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)*
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

* Indicates that this is the first year that the measure can be reported using ECDS

 

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening and Follow-up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional, which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

 

* HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

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