Anthem Blue Cross and Blue Shield and our subsidiary company, HMO Nevada (Anthem) would like to remind providers that our Treasure Island account members will present two (2) ID cards, an Anthem ID card and a Morgan White Premium Saver ID card, at the time of service. Both Anthem and Morgan White should be billed for services rendered with Anthem as the primary insurer and Morgan White as the supplemental, or secondary, insurer.

Below are images of the front and back of the Morgan White ID card that a Treasure Island Account member may present.

 

Morgan White ID card front:

Morgan White ID card back:


2696-0522-PN-NV

We’ve heard it all our lives: To be fair, you should treat everybody the same. But the challenge is that everybody is not the same—and these differences can lead to critical disparities not only in how patients access health care, but their outcomes as well. The COVID-19 pandemic has reignited public attention about the serious public health risks and consequences of disparities, and the critical need for health equity.

Health equity means everyone has the opportunity to reach their highest level of health, and barriers to doing so must be removed. Health disparities are health differences that are closely linked with social, economic, and/or environmental disadvantage.¹ Achieving health equity requires focus on the elimination of barriers and disparities associated with factors such as race, ethnicity, gender, gender identity, religion, socioeconomic status, disability, and even where you live.² As a result, it is imperative to offer access to care that is tailored to the unique needs of patients, and Anthem Blue Cross and Blue Shield is committed to supporting our providers in this effort. 

 

MyDiversePatients.com is where you can find resources, information, and techniques to help provide individualized care every patient deserves, regardless of their diverse backgrounds. There you can also find opportunities for free Continuing Medical Education (CME) credit for learning experiences on topics related to cultural competency and disparities. Mydiversepatients.com is free and accessible from any device (desktop computer, laptop, phone, or tablet) with no account or log in required. Scan the QR code below for direct access to mydiversepatients.com.

Stronger Together is a website where you can find free resources to support the diverse health needs of all people where they live, learn, work and play. These resources were created in collaboration with national organizations and are available for you to share with your patients and communities. Scan the QR code below for direct access to Stronger Together.

While there is no single, easy answer to address health care disparities, the vision of MyDiversePatients.com and Stronger Together is a start to reversing health care inequity one person at a time.

 

 

1Office of Disease Prevention and Health Promotion. (2022, Feb 6). Healthy People - Disparities. Retrieved from https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities

2Think Anthem.com. (2022, Feb 7). Why We Need Health Equity. Retrieved from https://www.thinkanthem.com/health-equity/what-are-health-disparities/

1805-522-PN-ALLCSBD

These guidelines are developed to provide helpful information on how to report services to Anthem Blue Cross and Blue Shield (Anthem) for the administration and observation of the drug Spravato®. 

 

Eskatamine is sold under the brand name Spravato® and is indicated for adults with treatment-resistant depression. Based on the prescribing information, patients who have the drug administered in the professional provider’s office should be monitored for 2 hours to assess for complications. 

 

A main component in understanding how to report the administration of this drug is to identify whether the professional provider has purchased the drug for administration or whether the drug has been supplied and reported by a pharmacy. There are specific codes to report for each scenario.

 

Professional provider purchased and administered:

For professional providers that supply, administer, and provide the required observation of Spravato®, one of the following packaged service codes should be billed and should not include separate billing of the drug or the billing of the post-administration observation:

 

HCPCS Code	Description
G2082	Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified healthcare professional and provision of up to 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation.
G2083	Office or other outpatient visit for the evaluation and management of an established patient that requires the supervision of a physician or other qualified healthcare professional and provision of greater than 56 mg of esketamine nasal self-administration, includes 2 hours post-administration observation.

 

Note:  When Spravato® is being supplied by the outpatient hospital and administered in an outpatient hospital, the facility should bill G2082 and G2083 in conjunction with revenue center code (RCC) 919 and the drug should not be billed separately.  In addition, there should not be a separate professional claim submitted as procedure codes G2082 and G2083 describe both the drug and the professional services.

 

Pharmacy supplied and professional provider administered:

When a pharmacy supplies Spravato® and is reporting this service in a separate claim, the drug should be billed with the HCPCS code, S0013 – Esketamine, nasal spray, 1 mg. 

 

If the provider administering Spravato® did not purchase the drug, then the provider should not report the supply of the drug on their claim, as this will be reported by the pharmacy.

 

Post-administration observation:

When the provider does not bill a packaged service code (listed above), the professional provider may report an Evaluation and Management (E/M) service including the appropriate prolonged services code. 

 

CPT Codes	Description
99202 - 99205	Office or other outpatient visit for the evaluation and management of a new patient
99212 - 99215	Office or other outpatient visit for the evaluation and management of an established patient
99417	Prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes

 

In accordance with the American Medical Association’s (AMA’s) CPT® Manual, CPT code 99417 should only be billed when reported with CPT codes 99205 and 99215. Medical records must support coding.  Please refer to Anthem’s Prolonged Services – Professional Reimbursement Policy for additional information.

 

2090-0522-PN-GANV

Change Healthcare will transition out of the post-payment hospital bill audit (HBA) program by the end of 2022. Effective immediately, Anthem’s complex and clinical audit (CCA) team will conduct the HBA program. For a short period of time, Change Healthcare may continue to contact you work that is in process, or already scheduled.

 

Anthem continues to work with Cotiviti as a post-payment DRG validation audit partner. Effective immediately, the Anthem CCA team is assuming a larger role in conducting post-payment DRG validation audits and DRG readmission audits. In addition to receiving requests from Anthem’s CCA team, network-participating providers may continue to receive letters from Cotiviti requesting access to medical records for the purpose of conducting these audits. We will do our best to avoid duplicate medical record requests from Anthem and Cotiviti. 

 

Thank you for your continued efforts to expedite medical record requests. 

 

This notification applies to all lines of business and all markets. If you have questions about this notification, please contact your local network consultant.

 

2120-0522-PN-ALLCSBD

Submitting your updates in a timely manner helps to ensure we have the most current online provider directory information available to members. We ask that you review your information regularly and let us know as soon as possible if any of your information in our online provider directory has changed.

 

If Commercial or Medicare updates are needed, you can use our online Provider Maintenance Form. If Medicaid updates are needed, you can use our online Practice Profile Update 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 or Practice Profile Update Form, you will receive an email acknowledging receipt of your request. Visit the Provider Maintenance Form landing page for complete instructions on how to use that form. If you have any questions or need assistance with the Practice Profile Update form, please contact your local Provider Relations representative or call 1-844-396-2330.

 

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 appreciate your help in keeping our online provider directories current.

 

2129-0522-PN-NV

This is a reminder to ensure that you are referring Anthem Blue Cross and Blue Shield (Anthem) members to participating labs. LabCorp is our preferred lab provider and offers a Single Source Solution to your testing needs. The relationship with LabCorp does not affect network hospital-based lab service providers, contracted pathologists, or contracted independent laboratories.  Physicians may continue to refer to all par providers as they have in the past.

 

Not only does your Anthem agreement obligate you to refer to participating labs where available, but members will only receive their full benefits from participating providers. As a result, referring your patient and our member to a non-participating lab may expose them to a greater financial responsibility. 

 

Unfortunately, there are certain non-participating labs that are offering to waive or cap co-payments, coinsurance, or deductibles to our members in order to increase their overall revenue. These practices undermine member benefits and may encourage over-utilization of services.

 

These billing practices are also questionable in their legality. Such a practice may present violations under state or federal anti-kickback laws.

 

For a listing of Anthem participating laboratories, please check our online directory. Go to anthem.com. Choose Select For Providers, and Providers Overview. Select Find Resources in Your State, and select Nevada. From the Provider Home tab, select the enter button from the blue box on the left side of page titled Find a Doctor . 

 

Note:  When searching for laboratory, pathology, or radiology services, under the field “I am looking for a:” select Lab/Pathology/Radiology; and then under the field “Who specializes in:”, select Laboratories, Pathology, or Radiology as appropriate for your inquiry.

 

LabCorp is our preferred lab provider and offers a Single Source Solution to your testing needs:

LabCorp is capable of providing services that range from routine testing, such as basic blood counts and cholesterol tests, to highly complex diagnosing of genetic conditions, cancers, and other rare diseases. LabCorp has specialized laboratories which cover the following areas of testing:

                                                                         

·Allergy Program ·Cancer Testing ·Cardiovascular Disease ·Companion Diagnostics ·Dermatology ·Diabetes ·DNA Testing ·Endocrine Disorders ·Esoteric Coagulation ·Gastroenterology

·Genetic Testing ·Genetic Counseling ·Genomics ·HLA Lab for National Marrow Donor Program ·Hematopathology ·Infectious Disease ·Immunology ·Liver Disease ·Kidney Disease

·Medical Drug Monitoring ·Molecular Diagnostics ·Newborn Screening ·Pain Management ·Pathology Expertise w/range of Subspecialties ·Pharmacogenomics ·Preimplantation Genetic Diagnosis ·Reproductive Health

·Obstetrics/Gynecology ·Oncology ·Toxicology ·Whole Exome Sequencing ·Virology ·Women’s Health ·Urology

 

Note:  This relationship with LabCorp does not affect network hospital-based lab service providers, or contracted pathologists.

 

To find a LabCorp location near you, go to LabCorp.com or call one of the phone numbers below.

 

For information about specialized assays or about requirements for special collection kits and specimen handling, call LabCorp at 303-792-2600 or toll free at 888-LABCORP (888-522-2677).

1931-0522-PN-NV

 

The annual PCP access studies performed by our vendor, North American Testing Organization based in California, were resumed and fielded in the third quarter of 2021. The purpose is to assess adequate appointment timeframes for our members with an urgent condition or for routine.

 

The main challenges the vendor encounters while attempting to collect this required, essential data are related to inaccurate provider information in the Anthem Blue Cross and Blue Shield (Anthem) demographic database, i.e., incorrect or non-working phone numbers, practitioner moved, retired, or deceased; the practice has resigned their Anthem contract, accepts private pay only or is no longer in practice; as well as, staff refusing to participate in the survey.  We ask that Commercial and/or Medicare contracted providers update office information using the online Provider Maintenance Form and that you participate in quality programs such as this critical survey as a condition of Anthem’s contract. Medicaid contracted provider office and demographic updates can be made by using our online Practice Profile Update Form.

Another item captured in the survey is open panel status for new patients.  At the office level, we are capturing more closed panel data than is reflected in the provider directory for members. Please keep Anthem abreast of the open/close panel status of your practice. 

 

What does this mean for our members?  If the directory indicates “open” and the practitioner is not available for new patients, the member is making multiple calls to select a primary care physician. Their experience is reflected in the annual CAHPS® member survey of Anthem enrollees, which indicated “not open to new patients” as the number one reason throughout Anthem plan’s for not getting a personal doctor.

 

To be compliant, per the provider manual, participating providers agree to meet the following access standards, whether in person or a telehealth visit:

• Urgent – The patient must meet with their Practitioner, another Practitioner in the practice or a covering Practitioner within twenty-four (24) hours.

• Explanation – These callers are experiencing a non-emergent condition or injury with acute symptoms that require immediate attention (without prior authorization).

• Initial Routine – A new patient must meet with a Practitioner or another participating Practitioner in the practice within 7 calendar days.

• Explanation – This is for the actual conversation with a professional after the intake assessment for non-urgent care; member needs or has been referred for a non-urgent condition. This is for a new patient.

• Routine – The patient must meet with their Practitioner, another Practitioner in the practice or a covering Practitioner within 10 business days.

• Explanation – A regular routine appointment is a non-symptom related visit for existing patients, such as a check-up, including physicals and chronic monitoring.

• Routine follow-up – The patient must meet with their Practitioner, another Practitioner in the practice or a covering Practitioner within 30 calendar days.

• Explanation – This is for an evaluation of progress or services, including, but not limited to, medication management. This includes new or existing patients.

Note to staff: It is imperative that your office updates any changes to your practice using our online Provider Maintenance Form for Commercial and Medicare, and our Practice Profile Update Form for Medicaid on anthem.com/provider.

 

2149-0522-PN-NV

Many resources are available for health professionals to support hypertension prevention and management and educate others. To support that effort, the Centers for Disease Control and Prevention (CDC)’s Division for Heart Disease and Stroke Prevention has put together these sets of educational materials for health professionals and patients:

• Hypertension Communications Kit: Health professionals can share these social media messages, graphics, and resources to educate their audiences about hypertension.
• Hypertension Patient Education Handouts: These fact sheets and handouts can help patients understand how hypertension affects their health and how to make healthy lifestyle changes.
• Hypertension Tools and Training: These materials can help health professionals develop and support programs for preventing and managing hypertension.

 

Visit the Million Hearts® website for more resources designed for health professionals. Million Hearts^® is a national initiative co-led by CDC and the Centers for Medicare & Medicaid Services (CMS). Million Hearts^® aims to prevent 1 million heart attacks and strokes within five years.

 

Measure Up: Controlling High Blood Pressure (CBP) HEDIS® measure

The HEDIS measure Controlling High Blood Pressure (CBP) assesses adults ages 18–85 with a diagnosis of hypertension and whose blood pressure was properly controlled based on the following criteria:

• Adults 18–59 years of age whose blood pressure was <140/90 mm Hg
• Adults 60–85 years of age, with a diagnosis of diabetes, whose blood pressure was <140/90 mm Hg
• Adults 60–85 years of age, without a diagnosis of diabetes, whose blood pressure was <150/90 mm Hg

 

Patient claims should include one systolic reading and one diastolic reading:

CPT II Code	Most recent systolic blood pressure
3074F	<130 mm Hg
3075F	130-139 mm Hg
3077F	≥ 140 mm Hg
CPT II Code	Most recent diastolic blood pressure
3078F	<80 mm Hg
3079F	80-89 mm Hg
3080F	≥ 90 mm Hg

 

When charting your patient’s blood pressure readings, in addition to the systolic and diastolic readings, and dates, if the patient has an elevated blood pressure, but does not have hypertension, note the reason for follow-up.

 

Additional tips for talking to patients:

• Continue to educate patients about the risks of hypertension
• Encourage weight loss, regular exercise and diet
• Advise patients who are smoking to quit
• Talk about chronic stress and ways to cope with it in a healthy way

 

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

 

Resource: Centers for Disease Control and Prevention. https://www.cdc.gov/bloodpressure/educational_materials.htm

 

2185-0522-PN-GANV

Material adverse change (MAC)

Effective with dates of service on or after August 1, 2022, Anthem Blue Cross and Blue Shield (Anthem) will facilitate review of selected claims for COVID-19 visits reported with evaluation and management (E/M) services submitted by professional providers to align with CMS reporting guidelines. When the purpose of the visit is for COVID-19 testing only, reimbursement for CPT^® code 99211 (office or other outpatient visit) is allowed when billed with place of service office (11), mobile unit (15), walk-in retail health clinic (17), or urgent care facility (20). Claims for exposure only may be affected. Professional providers are encouraged to code their claims to the highest level of specificity in accordance with ICD-10 coding guidelines.

 

Prior to payment, Anthem will review the selected claims to determine, in accordance with correct coding requirements and/or reimbursement policy as applicable, whether the E/M code level submitted is appropriate for the COVID-19 visit reported. If the visit is determined to be solely for the purpose of COVID-19 testing, Anthem will reimburse using CPT code 99211.

 

Professional providers that believe their medical record documentation supports reimbursement for the originally submitted level for the E/M service will be able to follow the Claims Payment Dispute process (including submission of such documentation with the dispute) as outlined in the provider manual.

 

If you have questions about this program, contact the Provider Experience team.

 

2135-0522-PN-GANV

The total economic cost of alcohol use disorder has been estimated to be $249 billion according to the Centers for Disease Control and Prevention (CDC)¹, $27 billion of which has been accounted for healthcare costs². The CDC projects the economic impact to society is about $807 per person, per year.³

 

Alcohol use disorder also impacts the economy through work force disruptions caused by tardiness, absenteeism, employee turnover and conflict in the workplace. It causes a reduction in potential employees, customer and taxpayer bases.⁴

 

According to the CDC, alcohol use was directly tied to 95,000 deaths annually between 2011 and 2015. This was more than all illicit substances combined. The CDC estimates that alcohol-attributed disease resulted in almost 685,000 years of potential life lost for the same period.

 

This chart shows the years of potential life lost (YPLL) related directly or indirectly to alcohol use disorder:

Cause	YPLL
Total YPLL	>2.7 million
100% alcohol attributed disease	684,750
Suicide	334,058
Motor vehicle crashes	323,610
Liver disease	202,391
Heart disease	118,021
Cancer	88,729

 

If you need assistance connecting your patients to opioid, substance use or alcohol use disorder treatment, contact your Anthem Blue Cross and Blue Shield health plan.

 

1Center for Disease Control and Prevention, 2019 https://www.cdc.gov/alcohol/features/excessive-drinking.html

2National Institute on Drug Use, 2018 https://archives.drugabuse.gov/trends-statistics/costs-substance-abuse

3Center for Disease Control and Prevention, 2019

4National Institute on Drug Use, 2018

 

2186-0522-PN-GANV

Medicare Advantage

 

Anthem Blue Cross and Blue Shield has partnered with Everlywell* to provide at-home lab tests for a subset of our eligible patients. We mail at-home test kits directly to patients’ homes with instructions on how to complete and return the kits. Clinical Laboratory Improvement Amendments-certified labs process the tests, and an independent physician reviews the results.

 

We provide PCPs a list of their patients who receive test kit(s) and send individual results to the patient and their doctor. You can help your patients navigate needed testing by encouraging them to complete kits mailed to them. A physician’s recommendation is a significant factor in patient screenings.

 

A patient may receive up to two at-home test kits:

• Fecal immunochemical test for colorectal cancer screening
• Hemoglobin A1c test to measure average glucose levels over the past two to three months for those with diabetes

 

How the program works:

• Test kit(s) are automatically mailed to eligible patients, and patient lists are sent to physicians.
• Patients collect samples at home, using instructions provided.
• Patients mail samples to Everlywell in the provided, postage-paid envelope.
• Individual test results are sent to patients and their primary care physician, providing evidence of preventive screening completion.

 

If you have questions about the at-home testing program, contact your local representative. For additional information about Everlywell, visit everlywell.com.

 

* Everlywell is an independent company providing at-home lab testing services on behalf of Anthem Blue Cross and Blue Shield.

 

ABSCRNU-0320-22

Medicare Advantage

 

The National Committee for Quality Assurance (NCQA) has changed, revised, and retired HEDIS® measures for measurement year 2022. Below is a summary of the key changes to be aware of.

 

Diabetes measures

NCQA has separated the Comprehensive Diabetes indicators into stand-alone measures:

• Hemoglobin A1c Control for Patients with Diabetes (HBD) (HbA1c Control < 8 and Poor Control HbA1c)
• Eye Exam Performed for Patients with Diabetes (EED)
• Blood Pressure for Patients with Diabetes (BPD)
• Kidney Health Evaluation for Patients with Diabetes (KED)

 

The process measure Comprehensive Diabetes HbA1c testing was retired as the goal is to move towards more outcome measures.

 

Race/ethnicity stratification

To address healthcare disparities, the first step is reporting and measuring performance. Given this, NCQA has added race and ethnicity stratifications to the following HEDIS measures:

• Colorectal Cancer Screening (COL)
• Controlling High Blood Pressure (CBP)
• Hemoglobin A1c Control for patients with Diabetes (HBD)
• Prenatal and Post-Partum Care (PPC)
• Child and Adolescent Well Care Visits (WCV)

 

NCQA plans to expand the race and ethnicity stratifications to additional HEDIS measures over several years tohelp reduce disparities in care among patient populations. This effort builds on NCQA’s existing work
dedicated to the advancing health equity in data and quality measurement.

 

New measures

Antibiotic Utilization for Respiratory Conditions (AXR): The percentage of episodes for members 3 months of age and older with a diagnosis of a respiratory condition that resulted in an antibiotic dispensing event

 

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

This measure was added given antibiotics prescribed for acute respiratory conditions are a large driver of antibiotic overuse. Tracking antibiotic prescribing for all acute respiratory conditions will provide context about overall antibiotic use. Given this new measure, the Antibiotic Utilization measure has been retired.

 

Deprescribing of Benzodiazepines in Older Adults (DBO): The percentage of Medicare members 65 years of age and older who were dispensed benzodiazepines and achieved a 20% decrease or greater in benzodiazepine dose during the measurement year

 

Guidelines recommend that benzodiazepines be avoided in older adults, and deprescribing benzodiazepines slowly and safely, rather than stopping use immediately. There is an opportunity to promote harm reduction by assessing progress in appropriately reducing benzodiazepine use in the older adult population.

 

Advanced Care Planning (ACP): The percentage of adults 65 to 80 years of age, with advanced illness, an indication of frailty or who are receiving palliative care, and adults 81 years of age and older, who had advance care planning during the measurement year 

 

Advance care planning is associated with improved quality of life, this measure will allow an understanding if it is provided to those who are most likely to benefit from it. Given this new measure, the Care for Older Adults measure has been retired.

 

Measure changes

Use of Imaging Studies for Low Back Pain (LBP): This measure was expanded to the Medicare line-of-business and the upper age limit for this measure was expanded to age 75. Additional exclusions to the measure were also added.

 

A complete summary of 2022 HEDIS changes and more information, can be found online.

 

Source: NCQA.org

 

ABSCRNU-0325-22

Medicare Advantage

Effective March 1, 2022, the following Part B medications from the current Clinical Utilization Management (UM) Guidelines will be included in our medical step therapy precertification review process. Step therapy review will apply upon precertification initiation, in addition to the current medical necessity review (as is current procedure). Step therapy will not apply for members who are actively receiving medications listed below.

 

Clinical UM Guidelines are publicly available on the provider website. Visit the Clinical Criteria page to search for specific criteria.

 

Clinical UM Guidelines	Preferred drug(s)	Nonpreferred drug(s)
ING-CC-0062	Inflectra Remicade, Infliximab (unbranded)	Avsola  Renflexis

 

 

ABSCRNU-0330-22

ABSCARE-1286-22

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).

 

Strategic Provider System to launch in May

In May 2022, Anthem will replace the current data management system with the new and significantly improved Strategic Provider System (SPS). The SPS data website will increase provider data accuracy, transparency, and timeliness, creating an enhanced provider experience.

 

SPS offers robust support features that will improve the ability of Anthem to match submitted claims, resulting in more accurate pricing and processing. The easy-to-use website will allow you to:

• Digitally submit demographic data to one location.
• Maintain, update, and verify demographic data using a single website.
• Receive clear on-screen alerts and guidance as you maintain your data.
• Obtain access to a simplified quick verification process that will allow you to complete required verifications online, eliminating the need to fax, email, or use separate online forms.
• Receive periodic reminders to help you keep your information current.

 

What you need to do to get ready for the change

If already enrolled in Availity,* no further action is needed. If you are not enrolled, go to availity.com and select the orange Register button. Availity is our secure provider website platform, where you can enjoy the convenience of digital transactions, including prior authorization and claims submission, as well as benefit and eligibility look-up.

 

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem.

ANV-NU-0324-22

ANV-NU-0284-21

Medicare Advantage

 

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

• March 2022 Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• April 2022 Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
• New specialty pharmacy medical step therapy requirements

 

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).

 

Strategic Provider System to launch in May

In May 2022, Anthem will replace the current data management system with the new and significantly improved Strategic Provider System (SPS). The SPS data website will increase provider data accuracy, transparency, and timeliness, creating an enhanced provider experience.

 

SPS offers robust support features that will improve the ability of Anthem to match submitted claims, resulting in more accurate pricing and processing. The easy-to-use website will allow you to:

• Digitally submit demographic data to one location.
• Maintain, update, and verify demographic data using a single website.
• Receive clear on-screen alerts and guidance as you maintain your data.
• Obtain access to a simplified quick verification process that will allow you to complete required verifications online, eliminating the need to fax, email, or use separate online forms.
• Receive periodic reminders to help you keep your information current.

 

What you need to do to get ready for the change

If already enrolled in Availity,* no further action is needed. If you are not enrolled, go to availity.com and select the orange Register button. Availity is our secure provider website platform, where you can enjoy the convenience of digital transactions, including prior authorization and claims submission, as well as benefit and eligibility look-up.

 

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem.

ANV-NU-0324-22

ANV-NU-0284-21

Medicaid

 

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

 

Electronic claims filing

If you are filing professional claims electronically (supported by electronic data interchange EDI), below are some tips for a successful claim submission:

• Billing provider — Loop (section) 2010:
  • When the billing provider is an organization healthcare provider, the organization’s national provider identification (NPI) number is reported in field NM109.
  • The taxpayer identification number (TIN) of the billing provider must be reported in the REF segment of this loop.
  • The billing provider may be an individual only when the healthcare provider performing the services is an independent, unincorporated entity.
  • The billing provider address must hold a physical address and should not contain any of the following: Post Office Box, P.O. Box, PO Box, Lock Box, or Lock Bin.
• Rendering provider — Loop 2310:
  • This loop or section of the EDI file is required when the rendering provider’s NPI is different from that carried in Loop ID-2010AA-billing provider. If not required by the EDI implementation guide, do not send.
  • The rendering provider is the person or company who rendered the care.

 

Mail claims filing

If you are filing a professional claim via mail:

• Facility information:
  • Include the address of the servicing facility — the address where services were rendered — in Box 32.
  • Include the servicing facility’s NPI — service location NPI — in Box 32a.
• Billing provider:
  • The billing provider’s complete name, address, and phone number must be in Box 33.
  • NPI must be reported in Box 33a (group’s organization or individual provider is an independent, unincorporated entity).
  • The TIN of the billing provider must be reported in Box 25.
• Rendering provider:
  • For claims that require a rendering provider, report the rendering provider NPI in Box 24J. 

 

Review your billing practices carefully to ensure proper TIN, billing NPI, and rendering provider information (if applicable) are submitted in the appropriate fields. Please bill according to your contracted network roster. If you are billing with a rendering NPI that you have not notified us about, you will see a claim rejection and/or claim denial. Please notify us about any practice changes, including providers joining or leaving your organization. As a reminder, claims submitted incorrectly will be denied and/or rejected.

 

Not set up with EDI?

Anthem has a strategic relationship with Availity* to serve as our Electronic Data Interchange (EDI) partner for all electronic data and transactions.

 

Health care professionals, billing services and clearinghouses who are new to the EDI space can register to exchange EDI transactions with Availity.

 

EDI Connection Services Startup Guide

Batch Electronic Data Interchange (EDI) Standard Companion Guide

 

Your organization can submit and receive the following transactions through the Availity EDI Gateway:

• 837- Institutional Claims
• 837- Professional Claims
• 837- Dental Claims
• 835- Electronic Remittance Advice
• 276/277- Claim Status
• 270/271- Eligibility Request
• 275- Electronic Medical Attachments
• 278- Prior Authorizations and Referrals

 

Payer Name and ID
Your payer name is Anthem BCBS Nevada and the payer ID is 00265
(If you use a billing company or clearinghouse for your EDI transmissions, please work with them on which payer ID they want you to use.)

 

Questions? We’re here to help.

If you have questions about this information, please contact your Provider Experience consultant or email us here.

 

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Healthcare Solutions.

ANV-NU-0301-21

Medicaid

 

The U.S. Food and Drug Administration (FDA) is warning that dental problems have been reported with medicines containing buprenorphine that dissolve in the mouth. The dental problems include tooth decay, cavities, oral infections, and tooth loss. This can be serious and has been reported in patients with no history of dental issues. Despite these risks, buprenorphine is an important treatment option for opioid use disorder (OUD) and pain. We ask our providers to take this information into account when prescribing buprenorphine medicines to our members.

 

Please refer to the FDA Drug Safety Communication to review the full notice.

 

ANV-NU-0314-22

Medicaid

 

High-prevalence demographics

The lifetime prevalence of AUD in the U.S. population is approximately 29.1%. However, only 19.8% of people with AUD receive treatment. Prevalence of AUD is high in white and Indigenous people, younger men (age < 65), unmarried people, and those with low incomes.¹

 

22.8 million people over the age of 12 reported having a substance use disorder (SUD) in 2019; AUD accounted for 63% of this population. An additional 12% presented with AUD and another SUD (excluding nicotine) according to the National Survey on Drug Use and Health (NSDUH).²

 

AUD and COVID-19

Evidence suggests that alcohol consumption increased during the COVID-19 pandemic. One study found that 60% of respondents reported increased alcohol-intake.³ In 2020, alcohol sales increased by 262% online and 21% in stores, which participants reported was due to increased stress, alcohol availability, and lockdown boredom.⁴ This increase was most substantial between March to April 2020. The study suggests those most affected by COVID-19 (job loss, friend loss, family loss, and isolation) may be more at risk of AUD.³

 

AUD co-occurring with mental health conditions

People with a variety of mental health conditions are at increased risk of developing an AUD or have an existing co-occurring AUD.⁵ While the rates are higher for co-occurring disorders with mental health conditions, there is also a higher risk of greater severity and a worse prognosis for both the mental condition and AUD. 

 

Trauma, including adverse childhood events (ACEs) and post-traumatic stress disorder (PTSD), are often precursors for AUD.⁶ Traumatic brain injuries (TBI) are also associated with AUD. Alcohol intoxication is one of the strongest predictors of a TBI. In addition, people with a TBI are more likely to abuse alcohol.⁷

 

In most co-occurring disorders, the mental health condition preceded the AUD. This indicates that people diagnosed with a mental health condition should be screened for AUD. Preventive work should begin at the onset of symptoms of a mental health condition.⁵

 

What if I need assistance?

If you have difficulty connecting patients with AUD to treatment, please contact Anthem Blue Cross and
Blue Shield Healthcare Solutions If you have questions about this communication or need assistance with any other item, call Provider Services at 844-396-2330.

 

1 Recovery Research Institute, 2019 https://www.recoveryanswers.org/addiction-101/epidemiology

2 Substance Abuse and Mental Health Services Administration, 2020 Results from the 2019 National Survey on Drug Use and Health

3 Pollard, Tucker, and Green (2020) https://doi.org/10.1001/jamanetworkopen.2020.22942

4 The Neilsen Company (2020) https://www.nielsen.com/us/en/insights/article/2020/rebalancing-the-covid-19-effect-on-alcohol-sales

5 Glantz et al., (2020) https://doi.org/10.1016/j.addbeh.2019.106128

6 Brady and Back (2012) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3860395

7 Weil, Corrigan, and Karelina (2018) https://pubmed.ncbi.nlm.nih.gov/31198656

 

ANV-NU-0317-22

Medicaid

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

• Medical Policies and Clinical Utilization Management Guidelines update
• Prior authorization requirement change for HCPCS code K1022
• New specialty pharmacy medical step therapy requirements