Commercial Risk Adjustment (CRA) reporting update: 2020 prospective program continues
We understand you are committed to providing the best care for our members, which may now include telehealth visits. Telehealth visits are an acceptable form for seeing your patients, and assessing if they have risk adjustable conditions in support of the Anthem Commercial Risk Adjustment (CRA) prospective program. The prospective program is well under way for 2020, and focuses on member health assessments for patients with undocumented Hierarchical Condition Categories (HCC’s), in order to help close patients’ gaps in care. We continue to provide updates regarding the prospective program to solicit your help getting patients in for a wellness visit before the calendar year ends, and we offer incentives to recognize your efforts (see details below.)
Inovalon – an independent company that provides secure, clinical documentation services – helps us comply with the provisions of the Affordable Care Act (ACA) that require us to assess members’ relative health risk levels. Please submit health assessments to Inovalon when completed and if you have questions, you can reach Inovalon directly at 877-448-8125.
Prospective program ask of providers:
Anthem network providers – usually PCPs – receive letters from Inovalon, requesting that they:
- Schedule a comprehensive in person or telehealth visit with patients identified by Inovalon to confirm or deny if previously coded or suspected diagnoses exists, and;
- Submit a Health Assessment documenting the previously coded or suspected diagnoses (also called SOAP Notes - Subjective, Objective, Assessment and Plan).
Incentives offered for properly submitted Health Assessments:
- $100 for each Health Assessment properly submitted electronically via Inovalon’s ePASS® tool
- $50 for each Health Assessment properly submitted via fax
ePASS® training is available to ensure health assessment completion accuracy:
- Training webinars every Wednesday - 3:00 p.m. - 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. Information will be provided on how to join the webinar.
Inovalon’s ePASS® tool is our preferred method for submission. However, we offer alternate options to be flexible and meet your needs. If in 2019 your practice utilized these alternative options for prospective member outreach, we thank you for continuing to utilize these alternative forms of program participation in 2020.
For those providers not familiar with alternative options, they are listed here. Telehealth visits are also an acceptable form of a patient visit for these alternative engagement options.
- EPHC providers using PCMS - Providers participating in our Enhanced Personal Health Care (EPHC) program can use member reports from our PCMS tool to schedule members for comprehensive visits. PCMS does have a link to take you directly to the Inovalon ePASS® tool where completed health assessments will result in a $100 incentive payment per submitted health assessment.
- List of members to be scheduled - Anthem CRA provides member/patient reports for providers to schedule members for comprehensive visits. No health assessment needed. Not eligible for additional incentive because CRA will get the diagnosis for gap closure through claims submission.
- EPIC Patient Assessment Form (PAF) - Providers with EPIC as their electronic medical record (EMR) system can fax the EPIC PAF to Anthem CRA at 855-244-0926 with a coversheet indicating "see attached Anthem Progress Note,” which is eligible for a $50 incentive payment.
- Providers Existing Patient Assessment Form (PAF) - Utilizes providers’ existing EMR system and applicable PAF. Must be submitted to Anthem CRA at 855-244-0926 with coversheet indicating, "see attached Anthem Progress Note“ which is eligible for a $50 incentive payment.
If you have any questions please contact Alicia Estrada, the Commercial Risk Adjustment Network Education Representative, at Alicia.Estrada@anthem.com.
Thank you for your commitment to assessing your patient’s health and closing possible gaps in care.
September 2020 Anthem Maine Provider News