Pregnancy notification process using the benefit look-up tool
Anthem uses the Benefit Look-Up Tool in the Availity Portal* to generate timely information about newly identified pregnant women. Early intervention helps improve birth outcomes and assists patients with accessing additional benefits as soon as possible. This does not replace submitting an electronic Pregnancy Risk Assessment Form (ePRAF) via NurtureOhio.
How it works
During the eligibility and benefits inquiry, if the member is of childbearing age, the office associate will be prompted to answer whether the member is pregnant or not. If the response is yes, the system will ask the due date, and a Maternity form is generated. Providers are asked to complete the form and provide additional information including the dates of the first prenatal and postpartum care visits.
Just follow these simple steps:
- Perform an eligibility and benefits request on a member of childbearing age and choose one of the following benefit service types: maternity, obstetrical, gynecological, obstetrical/gynecological.
- Before you see the benefit results screen, you will be asked if the member is pregnant and given a Yes or No option. If you indicate Yes, you will be asked what the estimated due date is. Fill in that date if you have an estimate or leave it blank if you do not.
- After you submit your answer, you will be taken to the benefits page. In the background, a Maternity Application form will be generated for this patient in the maternity application in Payer Spaces for Anthem.
Provider frequently asked questions
What is the purpose of the Availity Portal pregnancy notification process?
Anthem aims to identify all pregnant Anthem members early in their pregnancy so members can take full advantage of the education, support, resources, and incentives available through maternity programs like New Baby, New LifeSM.
When will the maternity screening questions display?
In the Availity Portal, the provider must choose one of four maternity service types (maternity, obstetrical, gynecological and/or obstetrical/gynecological) during the eligibility and benefits inquiry. For members 15 to 44 years of age, the system will then display a maternity screening consisting of two required questions. If the provider confirms the patient is pregnant, a Maternity Form is generated. If the patient is not pregnant, the desired eligibility and benefits information displays, and no further action is required.
What information is required on the maternity screening in the Availity Portal?
The following questions are required: “Is the patient pregnant?” and “What is the estimated due date?” If the estimated due date is not yet known, that question can be skipped; however, it will appear the next time a provider uses the eligibility and benefits lookup.
How is the information on the Maternity Form used?
The Maternity Form helps identify pregnant women so that maternity programs can be offered to them. As part of the process, all identified pregnant women receive an OB high-risk screening as well as appropriate prenatal, postpartum and well-child health education. Therefore, it is important that pregnancy data is correctly entered into the Availity Portal.
The Maternity Form is optional, but completing it is highly recommended so pregnancy support can be offered to members. For example, if Anthem sees a member has not yet had important prenatal and postpartum visits, we can help the member schedule these visits. It also notifies us if a pregnancy has ended prematurely so we can turn off pregnancy related health education messaging.
How should the provider respond when a member presents as a transfer from another OB provider?
You should answer the member pregnancy questions and complete the Maternity Form as usual. Even though the first prenatal visit question typically relates to prenatal care in the first trimester or within 42 days of plan enrollment, you can enter the date you first provided prenatal care for the patient.
If a member transfers out of our practice during her prenatal course, how should the provider complete the Maternity Form?
You can leave the Maternity Form in pending status as it still provides us with pertinent prenatal care information up to the point the patient transfers out of the practice. The form remains in place until it is automatically retired 19 months later.
If we have confirmed the patient is pregnant but suffers an early miscarriage or chooses to terminate their pregnancy, how should the provider communicate this information?
Select the option on the Maternity Form that states “This pregnancy ended or the baby delivered prior to 20 weeks.” This action allows the office to close out and submit the Maternity Form for this pregnancy. This will also notify us that any previously initiated maternity programs should be stopped.
Do I have to answer all questions on the Maternity Form at the same time?
No, the workflow is designed so you can enter and save information as it becomes available at multiple times during the pregnancy. After entering the delivery and postpartum visit dates, you are given the option to complete and submit the attestation. Until you are ready to submit the attestation, you may save information and continue with other tasks.
Is there an easy way for me to obtain a list of all patients for whom I need to enter prenatal or postpartum visit dates?
Yes, you will receive two notifications to complete the Maternity Form:
- The notification to complete the form and enter the first prenatal visit date is posted at the time the form is created.
- The second notification to alert you to schedule the postpartum visit and to enter the postpartum visit date is posted 14 days prior to the estimated due date.
You can access the work queue at any time under Payer Spaces. Select the payer title from the list and select Maternity.
How can I get additional help, support or training?
- Availity offers integrated help and on-demand training demonstrations (select Help or Find Help and search using the keyword maternity).
- You can launch a training demo from associated help topics as well as the Maternity work queue.
- If you have technical difficulties related to the Maternity workflow, contact Availity support at 800-282-4548.
If you have questions, please contact Provider Services at 844-912-1226.
February 2023 Anthem Provider News - Ohio