Notices of material changes/amendments to contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements. In this issue, please reference the following article:

• Specialty pharmacy updates - February 2022
• Clinical criteria updates for specialty pharmacy

The Consolidated Appropriations Act (CAA) effective January 1, 2022, contains a provision that requires online provider directory information be reviewed and updated (if needed) at least every 90 days. We are asking you to review your online provider directory information to help ensure Anthem members can locate the most current information for in-network providers and facilities.

You can help us ensure your online provider directory information is current by:

• Reviewing your online provider directory information on a regular basis to ensure it is correct. You can check your directory listing on Anthem’s Find Care Consumers, members, brokers, and providers use the Find Care tool to identify in-network physicians and other healthcare providers supporting member health plans. To ensure we have your most current and accurate information, please take a moment to access Find Care. Go to anthem.com, select Providers, then under Provider Overview, choose Find Care.
• Submitting updates and corrections to your directory information by using our online Provider Maintenance Form. Online update options include:
  • add/change an address location
  • name change
  • tax ID changes
  • provider leaving a group or a single location
  • phone/fax number changes
  • closing a practice location

Once you submit the Provider Maintenance Form, you will receive an email acknowledging receipt of your request. Visit the Provider Maintenance Form landing page, then select your state, for complete instructions.

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The Cancer Care Navigator (CCN) program is a comprehensive cancer support solution for oncologists and 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.
 

Providers 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 833-649-0669.

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The Consumer Assessment of Healthcare Providers and Systems (CAHPS) is an annual standardized survey conducted starting February 2022 through May2022 to assess consumers’ experience with their provider and health plan. A random sample of your adult or child patients may get the survey. Over half of the questions used for scoring are directly impacted by providers. These questions are:

• When you needed care right way, how often did you get care as soon as you needed?
• How often did you get an appointment for a check-up or routine care as soon as you needed?
• How often was it easy to get the care, tests, or treatment you needed?
• How often did you get an appointment to see a specialist as soon as you needed?
• How often did your personal doctor seem informed and up-to-date about the care you got from other doctors or other health providers?
• How would you rate your personal doctor?
• How would you rate the specialist you see most often?
• How would you rate all your health care in the last 6 months?

Interested in how you can improve CAHPS performance? We offer an online course for providers and office staff designed to learn how to improve communication skills, build patient trust and commitment, and expand your knowledge of the CAHPS survey. The Improving the Patient Experience course is available at no cost and is eligible for one CME credit by the American Academy of Family Physicians. It can be accessed at: https://www.mydiversepatients.com/le-ptexp.html

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Share information with patients about taking an active role in their heart health

National Wear Red Day is a great way to keep heart aware. It is also a great opportunity to have a conversation with your patients about their heart health. The Centers for Disease Control and Prevention (CDC) has information you can share with your patients, including a helpful Know the Facts about Heart Disease flyer that’s free for health care professionals.

Controlling high blood pressure, diabetes, extra weight and unhealthy diets are heart disease contributors that you can help your patients recognize. For information about these heart disease risks to share with your patients, use the CDC website for toolkits, flyers and give-a-ways.

Measure Up: Controlling High Blood Pressure (CBP)

Known as the “silent killer,” high blood pressure or hypertension increases the risk of heart disease.

The HEDIS® measure CBP looks at the percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (140/90) in the measurement year. Record all blood pressure readings and the dates they were taken being sure to record the exact reading. Blood pressure readings captured during a telehealth, virtual care, telephone or e-visit should also be recorded.

Measure Up: Statin Therapy for Patients with Cardiovascular Disease and Diabetes (SPC/SPD)

Statins are effective at lowering cholesterol and protecting against a heart attach and stroke. Patients with diabetes also have elevated cardiovascular risk.

• Statin therapy for patients with cardiovascular disease (STC). HEDIS measure assesses males 21-75 years of age and females 40-75 years of age who have clinical atherosclerotic cardiovascular disease and who received and adhered to statin therapy.
• Statin therapy for patients with diabetes (STD) assesses adults 40-75 years of age who have diabetes and who do not have clinical ASCVD, who received and adhered to statin therapy.

Adherence to prescribed medication is key to patient care and SPC/SPD measure success.

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

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Effective November 1, 2021, EnrollSafe* at https://enrollsafe.payeehub.org replaced
Enrollhub® from the Council for Affordable Quality Healthcare, Inc. (CAQH) as the electronic funds transfer (EFT) enrollment website at no cost to ME AMH Health, LLC providers.

EnrollSafe is safe, secure, and available 24-hours a day

Log onto the EnrollSafe enrollment hub at https://enrollsafe.payeehub.org to enroll in EFT. You will be directed through the EnrollSafe secure website to the Registration page, where you will provide the required information to create an account and then Enroll to supply your banking information.

Already enrolled in EFT through CAQH Enrollhub?

If you were previously enrolled in EFT through CAQH Enrollhub, no action is needed unless you are making changes. Your EFT enrollment information will not change as a result of the new enrollment hub.

If you have changes to make, use https://enrollsafe.payeehub.org to update your account.

For more information or additional questions regarding the EnrollSafe Enrollment Hub portal, the provider can contact the Support team by calling 877-882-0384, Monday through Friday, 9 a.m. to 8 p.m.

*EnrollSafe is a tool developed by Zelis Payments, an independent organization offering electronic fund transfer services on behalf of ME AMH Health, LLC.

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