We are pleased to share that Paul Marchetti has been named Senior Vice President, Network and Care Delivery Transformation for Anthem. Paul joined Anthem October 22 and will have responsibility for Anthem’s overall care transformation strategy.

 

Paul is a respected leader who has more than 25 years of payer and provider experience in healthcare delivery systems, business operations, product development and population health, and technology solutions. Paul joins Anthem from New Century Health, a specialty care management company, where he served as Chief Growth Officer and led top-line revenue growth, strategic planning and execution and product development. Prior to his current role, Paul held leadership roles at Aetna, United HealthCare, Horizon Healthcare and Physicians Health Services.

 

Paul looks forward to meeting and engaging with our healthcare professionals and payers to evolve the healthcare system to one that is simpler, more accessible and more affordable for all Americans.

This is a reminder that any correspondence faxed to Anthem must include a valid Anthem member identification (ID) number. If available, please also include a copy of the member’s ID card. Any missing information will delay its processing.

 

Recently, we have seen a high instance of providers faxing appeals to us without a valid Anthem member ID number.

 

Appeals that do not have a valid Anthem member ID number will be returned by fax to the sender advising that this information is needed before we handle your request.

There is a new report available for oncology practices from Anthem via Availity. Using a unique predictive analytics model, the report scores chemotherapy patients at a practice with their risk for a potentially avoidable admission. The weekly report uses many variables to determine a patient’s individual risk for being admitted to the hospital while in treatment. This tool can help an oncology practice to be aware of high risk patients, and plan interventions or resource utilization accordingly. The tool was piloted with five practices including community and academic oncology with positive feedback.

 

This report is accessible through the Availity portal as shown below. For questions about this report or about Anthem’s Cancer Care Quality Program please email: cancer.quality@anthem.com.


Location of Report in Availity:

1. Make sure user has Log In for Availity and access to the online reporting function.
2. Click MORE option (Tab up top)
3. Click PROVIDER ONLINE REPORTING
4. REPORT SEARCH, then Avoidable Admissions (Weekly), then TAX ID, then PICK DATE, then VIEW
5. Will pop up as a Excel

 

Effective October 14, 2018, Anthem BCBS will enforce the requirement to bill the correct modifier and HCPCS for services utilized.  Incorrect billing will be rejected and claims will be returned to the provider for correction and resubmittal.

 

Durable Medical Equipment (DME) may be purchased, rented or rented until the purchase price has been paid. 

 

Correct billing will allow member benefits to be applied correctly to include benefit accumulations for a member’s DME benefits.

General Motors (GM) salaried employees living in Allen, Kosciusko, Miami and Wells County may have a health care plan which accesses the new Anthem HealthSync network. These members will have member identification cards issued by Blue Cross Blue Shield of Michigan with an alpha prefix of “IYU” and include the network name “HealthSync” on the front of the card.

 

     

SUMMARY OF BENEFITS: Services Rendered in Indiana

Mental Health and Substance Abuse Services use the National PPO (BlueCard PPO) Network for Level 1 benefits (90%/10% after the In-Network Deductible is met) in all states, including Indiana. Precertification/Prior Authorization for these services are managed by New Directions on behalf of BCBS of Michigan/General Motors.

 

NOTE:  Medical services received within the state of Indiana must be provided by a provider participating in the Anthem HealthSync Network to be considered Level 1 (In-Network).  Members traveling or living outside the state of Indiana may access the BlueCard PPO Network for In-Network (Level 1) Medical Benefits.