 Provider News NevadaJanuary 1, 2022 January 2022 Anthem Provider News - NevadaParents may not understand the importance of taking their children to the doctor when they are healthy. The benefits are documented by the American Academy of Pediatrics 1 as well as the Centers for Disease Control and Prevention 2 and it all starts with a recommendation by you, the trusted physician. Share these benefits with parents during regularly scheduled well-visits, or even during sick visits, to reinforce the importance of staying on track:
- Regular wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.
- Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.
- Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.
- Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.
Measure up: Well-Child Visits in the first 30 months of life (W30)
This HEDIS® measure is described as the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months. These rates are reported:
- Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.
- Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.
Tips
- Telehealth visits are acceptable in meeting the measurement requirements.
- Consider scheduling well-child visits in advance of the child reaching the age for the visit.
Coding
- ICD-10:110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2
- HCPCS: G0438-G0439, S0302
- CPT: 99381-99382, 99391-99392, 99461
Anthem Blue Cross and Blue Shield (Anthem) is pleased to announce that Caesar’s is a new client effective January 1, 2022. Caesar’s will be accessing Anthem’s PPO network with one exception. In Las Vegas, Caesar’s will be utilizing the Coalition’s hospital network rather than Anthem’s PPO network.
This new group will have a unique alpha prefix of C2T for each of the PPO plan options. Please see the sample copy below of the Health Plan ID cards. Please note the ID cards below are just samples, and do not include actual member information such as copays, but will be included when the ID cards are generated and sent to members prior to the effective date.)
Sample HSA Plan member ID card:
Sample PPO Plan member ID card:
Operational procedures for Caesar’s are the same as any other local Plan members. As with other local Plan members, utilize the contact information below:
- Claims should be filed directly to your local Anthem Blue Cross and Blue Shield office, either electronically or mailed to:
Anthem Blue Cross and Blue Shield
P.O. Box 5747
Denver, CO 80217-5747
- Online self-service options are available to providers, giving you access to the same information you receive when calling customer service, and provides patient-specific information such as eligibility, benefits, claim status, line-level detail, and payment information. These options include:
Blue High Performance Network plans offer access to providers with a record of delivering high quality, efficient care. BlueHPN ® networks first went live on January 1, 2021 in more than 50 cities across the country. Since then, our national customer base has grown, and we have even more members enrolled in plans with access to our high performance network for 2022.
Member ID cards and other Plan materials feature one small change for 2022: BlueHPN written as a single word rather than two.
As a reminder, BlueHPN is a national network designed from our local market expertise, deep data, and strong provider relationships, and aligned with local networks across the country. These local networks connect to the national chassis to form a national BlueHPN network. In Nevada, the Pathway HMO network is our Blue High Performance Network. Providers participating in the Pathway HMO will be in-network for any members with Blue High Performance Network plans.
If you are not sure whether your practice is part of the Pathway HMO network and therefore Blue High Performance Network, ask your office manager or contact your Anthem network consultant. Blue High Performance Network participation is displayed in provider profiles in Anthem’s provider directory.
As was true in 2021, you may see patients accessing this network through either a national employer plan, Blue High Performance Network, or large group employer plans with access to the Pathway HMO network. Under these plans, out-of-network benefits are limited to emergency or urgent care. Members must select a primary care provider, but PCP referrals are not required for specialty care.
Below is a sample ID card for a member from Nevada enrolled in a national employer BlueHPN plan for the 2022 benefit year. Note the new “Blue High Performance Network” logo and “BlueHPN” indicator in the suitcase icon.
Note: The High Performance Network acronym HPN is not used in conjunction or affiliated with any other local organizations known by the same acronym.
ATTACHMENTS (available on web): 1506 image.jpg (jpg - 0.02mb) To view the 2022 benefits and changes for the Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program® (FEP), go to fepblue.org then click Tools & Resources at the top of the page, and then click Brochures & Resources. Here you will find Plan Brochures, Plan Summaries, and Quick Reference Guides on information for year 2022. For questions, please contact FEP Customer Service at 800-282-2473.
Routinely, the Centers for Medicare & Medicaid Services (CMS) issue revisions to the average sales price (ASP) fee schedules regarding drug pricing. To that end, CMS is supplying the first quarter fee schedule with an effective date of January 1, 2022.
These fee schedules will go into effect with Anthem Blue Cross and Blue Shield (Anthem) on February 1, 2022. To view the ASP fee schedule, please visit the CMS website.
Medicare Advantage
Effective January 1, 2022, IngenioRx/CVS Specialty Pharmacy* will no longer distribute the brand name drug Botox®. However, Botox will still be available to Anthem Blue Cross and Blue Shield members through other vendors.
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 IngenioRx/CVS Specialty Pharmacy to obtain Botox, no action is needed.
For Botox managed under a Medicare member’s part B (medical) benefit
Providers should be using buy and bill for any Medicare member who currently receive Botox through their part B (medical) benefit. If your patient is receiving, Botox using their part B benefit and is receiving their prescription from IngenioRx/CVS Specialty pharmacy, effective January 1, 2022, IngenioRx/CVS Specialty will no longer filled the prescription. As of January 1, 2022, you will need to buy this drug and bill your patient’s health plan.
If you have questions regarding a Medicare member’s part B benefits, call Provider Services using the information on the back of the member’s ID card.
For Botox managed under a Medicare member’s part D (pharmacy) benefit
Effective January 1, 2022, Medicare members who currently receive Botox through IngenioRx/CVS Specialty Pharmacy using their part D (pharmacy) benefit must change to another in-network specialty or retail pharmacy that can obtain and dispense Botox.
If you have questions regarding a Medicare member’s part D benefit, call Pharmacy Member Services using the information on the back of the member’s ID card.
Medicare Advantage
The HEDIS® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care 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: https://www.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)
Medicaid
Please continue to check Medicaid Provider Communications & updates at anthem.com/nvmedicaiddoc for the latest Medicaid information, including:
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