Administrative Digital SolutionsMedicare AdvantageMay 1, 2024

Personalized Match update

Find Care, the doctor finder and transparency tool in the Anthem online directory, provides Anthem members with the ability to search for in-network providers using the secure member website. This tool currently offers multiple sorting options, such as sorting providers based on distance, alphabetical order, and provider name.

We previously introduced you to Personalized Match, an additional Find Care sorting option for Medicare Advantage members, which was based on provider efficiency and quality outcomes, in addition to member search radius. Personalized Match was initially limited to PCP searches and was later expanded to include certain specialists.

Beginning in June 2024 or later, we will further enhance Personalized Match. Provider availability and STARS rating scores will now more directly influence provider rankings. Additionally, provider recommendations will be driven in part by knowledge about member history derived from claims and other available clinical data. Personalized Match will continue to display providers with the highest overall ranking within the member’s search radius at the top of search results. Members may continue to sort based on distance, alphabetical order, and provider name:

  • A copy of the Personalized Match phase two methodology will be posted in Availity in the coming weeks.
  • If you have general questions regarding this new sorting option, please submit an inquiry via the web at Availity.
  • If you would like information about your quality or efficiency scoring used as part of this sorting option or if you would like to request reconsideration of those scores, you may do so by submitting an inquiry to Availity.

Anthem will continue to focus and expand our consumer tools and content to assist members in making more informed and personalized healthcare decisions. We are committed to helping patients more easily access the care they need.

Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: May 2024 Provider Newsletter