Procedure searches in Find Care
The algorithms used to sort procedure type use a combination of member and provider features to sort and display the results for a member’s search. The sorting results take into account member factors such as the member’s medical conditions and demographics. Provider factors such as surgeon-facility pairing (an individual provider who performs a procedure at a specific facility), cost efficiency measures, volumes of patients treated across various disease conditions, and outcome-based quality measures.
Combined member and provider features generate a unique ranking of surgeon-facility pairings or facility providers for each member conducting the procedure search. Displayed first are surgeon-facility pairings with the highest overall ranking within the search radius. Remaining pairings are displayed in descending order based on overall rank and proximity to the center of the search radius.
Personalized match procedure searches is expanding to include additional procedures on or after November 19, 2021. Anthem will use an updated episode of care methodology for these new procedures. The episode of care methodology for procedure searches that became available earlier this year will remain unchanged. The personalized match methodology for specialty-based provider searches remains unchanged. Members continue to have the ability to sort from a variety of orders such as distance. This enhancement in sorting methodology has no impact on member benefits.
Providers may review a copy of the procedure sorting methodologies, including the updated episode of care methodology for procedures added on or after November 19, 2021, by going to Availity and then using the following navigation: Go to Availity > Payer Spaces > Anthem > Information Center > Administrative Support > Personalized Provider Procedure Search Methodology for Expanded Set of Procedures.pdf
If you have general questions about the Find Care tool or the change to the quality measures for procedure searches, please call the number on the back of the member’s ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative.
If you would like detailed information about quality or cost factors used as part of this unique sorting or you would like to request reconsideration of those factors, you may do so by emailing email@example.com or by calling 833-292-2601.
October 2021 Anthem Provider News - Nevada