Apr 1, 2020 • State & Federal / Medicare

Effective, January 1, 2020, Anthem Blue Cross and Blue Shield (Anthem) entered into a provider collaboration agreement with Physician’s Group of Southeast Ohio Physicians in the southeastern Ohio market called Trusted Senior Care Advantage. Anthem delegated responsibility for medical claims payment, prior authorizations, case management, provider credentialing, and inpatient and outpatient utilization management to each of these groups for individual Medicare Advantage HMO members in Fairfield, Guernsey, Morgan, Muskingum, Noble and Perry counties who are attributed to Physician’s Group of Southeast Ohio Physicians. The delegation was effective January 1, 2020. Members under this arrangement will have Trusted Senior Care Advantage on their member ID card.

Trusted Senior Care ID card

Please see the frequently asked questions and answers below for additional information. You may also call Trusted Senior Care Advantage Provider Services at 1-833-440-5652.

 

Frequently Asked Questions (FAQ)

 

When did this relationship start?

This relationship started January 1, 2020.

 

What changes can I expect?

Certain services historically performed by Anthem have been delegated to Trusted Senior Care Advantage. Trusted Senior Care Advantage will provide services for payment of medical claims, provider credentialing and utilization management. As a result of these administrative changes, providers can expect increased interaction and collaboration between Anthem and Trusted Senior Care Advantage.

 

What number should I call if I have questions?

For provider inquiries, call Trusted Senior Care Advantage Provider Services at 1-833-440-5652.

 

What service area is Trusted Senior Care Advantage handling?

The service area includes the following counties: Fairfield, Guernsey, Morgan, Muskingum, Noble and Perry counties.

 

To what address do I submit claims?

Claims for routine vision services should be submitted to EyeMed (also known as Blue View Vision). All other medical claims should be submitted to the following address for payment:

Attn: Core Care Select

P.O. Box 70032

Anaheim, CA 92825

 

Electronic claims can be sent to Office Ally or Change Healthcare:

  • Office Ally payer ID: AGL02
  • Change Healthcare payer ID: 52352

 

For claim submission questions, contact Trusted Senior Care Advantage Provider Services at 1-833-440-5652.

 

Whom do I contact if I have questions about or need assistance with electronic data interchange?

Contact Trusted Senior Care Advantage Provider Services at 1-833-440-5652 for inquiries related to your electronic claims submission. They will assist in identifying, testing and correcting any issues.

 

Will there be a separate provider directory?

No, members will be able to refer to their Anthem provider directory as usual.

 

Where should I direct my patients if they have questions about their insurance plan?

Members should contact Anthem’s Member Services at the phone number on the back of their ID card.

 

Will prior authorization be required for admissions and/or certain services?

Yes, prior authorization is required for all nonemergency admissions and certain other services. For emergency admissions, please call Trusted Senior Care Advantage Provider Services at 1-833-440-5652 within 24 hours of admission or fax a face sheet to 1-614-259-0287.

 

How do I contact the Utilization and Quality Management departments?

  • Provider Services phone: 1-833-440-5652
  • Direct fax: 1-614-259-0293
  • Inpatient and Outpatient Case Management department fax: 1-614-259-0287

 

508031OHPENABS

 


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April 2020 Anthem Provider News - Ohio