SmartShopper® program update
The October 2017 and December 2017 editions of Network Update shared information about the SmartShopper® program which Anthem, in partnership with Sapphire Digital (formerly Vitals®), began offering to our small group members in Maine effective January 1, 2018. Please be advised effective September 1, 2020, all Anthem small group and large group fully insured members that are eligible for SmartShopper will receive enhanced telephonic concierge support for total knee and hip replacement, spine surgery and bariatric surgery. As part of the concierge model, Sapphire will guide members to facilities that are deemed as high-value based on cost and quality measures in order to qualify for rewards.
As a reminder, the SmartShopper® program does not take the place of any precertification/prior authorization requirements you may have as a participating provider. All referral and precertification/prior authorization requirements remain in place.
Sapphire utilizes data from the National Consumer Cost Transparency (NCCT) database, developed by the Blue Cross Blue Shield Association, to determine procedural costs in the SmartShopper® program. The NCCT data is refreshed bi-annually in May and November. Providers may view their data by accessing the current version of the NCCT data via the Anthem POIT web tool through Availity. Sapphire utilizes the Blue Distinction Center designation developed by the Blue Cross Blue Shield Association to determine facilities that have received Blue Distinction Center designation based on quality. If you have any questions regarding the NCCT data, please contact David Spencer, Provider Network Manager Senior, at 207-822-8453 or firstname.lastname@example.org.
July 2020 Anthem Maine Provider News