Material adverse change (MAC)

 

Anthem Blue Cross and Blue Shield (Anthem) entered into a pilot program to accept electronic medical attachment from VYNE Medical. This pilot program expired and the grace period for submitting electronic attachments through VYNE Medical has expired.

On May 1, 2022, attachments submitted through VYNE Medical will no longer be accessible by Anthem.  Thus, you may not submit attachments for claims you are submitting to Anthem through VYNE. The alternative for submitting medical attachments is through Electronic Data Interchange (EDI) or through Availity.com. This will ensure your medical attachments re appropriately received and aligned to the correct claim.

 

If you are not enrolled in Availity.com and EDI, the process is simple. Log onto Availity.com/provider-portal-registration to go through the step-by-step process for enrollment. For information about how to enroll in EDI, use this convenient Batch EDI Standard Companion Guide after logging onto Availity.com.

 

For more information about enrolling in Availity, contact their client services department at

800-282-4548, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.

 

314-0222-PN-NV

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 Blue Cross and Blue Shield (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/provider, 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 for complete instructions.

 

1538-0222-PN-NV

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 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 heart attack 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).

1535-0222-PN-NV

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? Anthem offers 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 mydiversepatients.com/le-ptexp.html.

1514-0221-PN-NV

The Cancer Care Navigator (CCN) program is a comprehensive cancer support solution for oncologists and Anthem Blue Cross and Blue Shield (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 1-833-649-0669.

 

1515-0222-PN-NV

Medicare Advantage

 

Effective November 1, 2021, EnrollSafe* at 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 Anthem Blue Cross and Blue Shield providers.

 

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

Log onto the EnrollSafe enrollment hub at 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 enrollsafe.payeehub.org to update your account.

 

 

*EnrollSafe is a tool developed by Zelis Payments, an independent organization offering electronic fund transfer services on behalf of Anthem Blue Cross and Blue Shield.

 

ABSCRNU-0287-21

Medicaid

Please continue to check Medicaid Provider Communications & updates at anthem.com/nvmedicaiddoc for the latest Medicaid information, including:

• InterQual 2021.1 revisions
• Attention: Billing and coding reminder for Nevada Medicaid spine surgeons

 

Medicaid

 

We have made some recent changes to the Anthem Blue Cross and Blue Shield Healthcare Solutions provider manual for Nevada Medicaid.

 

Our updated provider manual is available for use and distribution as of January 1, 2022. You can obtain a copy by visiting the following website: providers.anthem.com/nv.

 

If you have any questions regarding these changes, please contact your Provider Experience associate at 844-396-2330.

 

ANV-NU-0299-21

Medicaid

 

This communication applies to Medicaid under Anthem Blue Cross and Blue Shield Healthcare Solutions and Medicare Advantage under Anthem Blue Cross and Blue Shield (Anthem).

 

The HEDIS^® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality healthcare services. 

 

The ECDS Reporting Standard provides a method to collect and report structured electronic clinical data for HEDIS quality measurement and improvement. 

 

Benefits to providers:

• Reduced burden of medical record review for quality reporting
• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

 

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

 

Learn more about NCQA’s digital quality system and what it means to you and your practice at the following link: ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

 

ECDS measures

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure. In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

 

For HEDIS measurement year 2022, the following measures can be reported using ECDS: 

• Childhood Immunization Status (CIS-E)*
• Immunizations for Adolescents (IMA-E)*
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)*
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

 

* Indicates that this is the first year that the measure can be reported using ECDS.

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening, and Follow-Up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional, which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

 

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

 

ANV-NU-0289-21

Medicaid

 

This communication applies to Medicaid under Anthem Blue Cross and Blue Shield Healthcare Solutions and Medicare Advantage under Anthem Blue Cross and Blue Shield (Anthem).

 

Effective November 1, 2021, EnrollSafe* at 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 Anthem providers.

 

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

Log onto the EnrollSafe enrollment hub at 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 enrollsafe.payeehub.org to update your account.

 

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

ANV-NU-0288-21

Medicaid

Please note:

• This is not a change in member benefits. This is a change in the Botox vendor only.
• If the member is not using CVS* Specialty Pharmacy or IngenioRx* Specialty Pharmacy to obtain Botox, no action is needed.

 

For Botox managed under a member’s medical benefit

Effective January 1, 2022, you will need to buy this drug and bill Anthem Blue Cross and Blue Shield Healthcare Solutions.

 

If you have questions regarding a member’s medical specialty pharmacy benefits, call Provider Services at 844-396-2330.

 

For Botox managed under a member’s pharmacy benefit

Effective January 1, 2022, members who currently obtain Botox through IngenioRx Specialty Pharmacy using their pharmacy benefit must change to another in-network pharmacy that distributes Botox.

 

If you have questions regarding a member’s pharmacy benefit, call Pharmacy Member Services at 833-207-3116.

 

* CVS is an independent company providing pharmacy services on behalf of Anthem Blue Cross and Blue Shield Healthcare Solutions. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem Blue Cross and Blue Shield Healthcare Solutions.

ANV-NU-0287-21

Medicaid

The Behavioral Health Areas of Expertise Profile (BHAEP) is designed to highlight your behavioral health network providers’ services, cultural preferences, race, languages spoken, and other specialties to our members through the enhancement of our online provider directory. The goal is to help our members find the right behavioral health provider to fit their unique needs. 

 

Contracted Medicaid providers are asked to answer a brief online survey on their clinical areas of expertise, demographics, modalities, and accessibility. The data collected provides insight into our behavioral health providers’ capabilities, which assists in member referral, provider network strategy development, and proposal support. Completion of the BHAEP does not affect a provider’s credentialing materials/status or contract.

 

By capturing this information, we are able to:

• Improve identification of specific services and/or specialties.
• Improve the referral process by better identifying provider capabilities.
• Align with competitors that provide this data in their online provider directories.

 

Currently, the BHAEP is administered in 18 Medicaid markets. The local health plan completes provider outreach. While data gathered through this tool has proven to be helpful to members, providers, and the health plan, response rates remain low.

 

View your State’s BHAEP survey here.

 

ANV-NU-0285-21

Medicare Advantage

 

Please continue to check Important Medicare Advantage Updates at anthem.com/medicareprovider for the latest Medicare Advantage information, including:

• NYC Medicare Advantage Plus update

 

Medicare Advantage

 

This communication applies to Medicaid under Anthem Blue Cross and Blue Shield Healthcare Solutions and Medicare Advantage under Anthem Blue Cross and Blue Shield (Anthem).

 

The HEDIS^® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality healthcare services. 

 

The ECDS Reporting Standard provides a method to collect and report structured electronic clinical data for HEDIS quality measurement and improvement. 

 

Benefits to providers:

• Reduced burden of medical record review for quality reporting
• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

 

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

 

Learn more about NCQA’s digital quality system and what it means to you and your practice at the following link: ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

 

ECDS measures

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure. In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

 

For HEDIS measurement year 2022, the following measures can be reported using ECDS: 

• Childhood Immunization Status (CIS-E)*
• Immunizations for Adolescents (IMA-E)*
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)*
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

 

* Indicates that this is the first year that the measure can be reported using ECDS.

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening, and Follow-Up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional, which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

 

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

 

ANV-NU-0289-21