What are three things everyone should know about you?

I love Disney! The magic of Disney brings so much happiness to my life and inspiration to me. As Walt Disney said, “All our dreams can come true, if we have the courage to pursue them.” This quote is in my back pocket every day for my career growth. Fun fact, I watch at least one Disney movie a day as well as I have two babies named Luke and Leia!

I am very driven about my job at Anthem Blue Cross and Blue Shield (Anthem). My professional surroundings would say I absorb like a sponge. Every day, I learn something new and use it to my advantage to help providers, coworkers, or career advancement. Anthem has been so rewarding to me and has given me a whole new perspective for members as well as providers.

I am very passionate about animals. If I could, I would save every animal in the world! I have seven animals: three dogs and four cats, and each of them having their own little personality and bring so much joy and laughter to me.

What is one thing you never leave home without?

I never leave home without my phone. My phone is my source of communication and has air drop, which allows my husband and me to share our locations. My phone has apple pay, which is essentially a virtual debit/credit card and has my home alarms and camera linked and in case of an emergency it has my contacts and personal health information.

Who has been most influential in your life?

My aunt has been the most influential person in my life. She has been a guiding light to my life and has helped shape me to be the woman I am today. Many folks will say I resemble my grandma, who raised her. My grandma passed when I was a young child, but I believe my aunt is the angel of her. My aunt is extremely driven, passionate, and always sees the good in an individual, which has embraced me to always take the best route in life. When I need a shoulder to cry on, a laugh to share, or someone’s company, she’s always the person that comes to mind.

Effective for claims processed on or after December 1, 2023, the editing systems at Anthem Blue Cross and Blue Shield will be updated to align with the American Medical Association (AMA) CPT^® Manual, HPCPS Level II Manual, and Centers for Medicare & Medicaid Services (CMS) correct coding guidelines, for the following services:

• Ulcer debridement and ulcer staging:

  • According to the ICD-10 Diagnosis Coding Manual, specific diagnosis codes that reflect the stage of the ulcer should be billed with the appropriate CPT code. For example, if billing a stage 3 pressure ulcer code, a stage 4 diagnosis code should not be reported.
  • According to the AMA CPT Manual, a debridement of an ulcer should be reported with the appropriate diagnosis code that reflects that service.

• Billing of anatomical modifiers:

  • According to the AMA CPT and HCPCS Level II manuals, the appropriate anatomical modifier is required to be appended to the appropriate procedure code. If not, the claim line will be denied. These modifiers designate the body part that a service is being performed on (for example, FA: Left hand, thumb, TA: Left foot, great toe).

• Billing of interprofessional telephone/internet consultations:

  • These billed procedure codes will follow the AMA CPT Manual coding guidelines.

Claim lines not billed in accordance with the correct coding guidance outlined above will be denied.

If you disagree with a claim reimbursement decision, please follow the claim dispute process (including submission of such documentation with the dispute) as outlined in the Provider Manual.

If you have questions about this communication or need assistance with any other item, contact your provider relationship management representative.

With your help, we can continually build towards a future of shared success.

In 2024, the annual PCP Access Studies Office Level Survey will be performed by a new vendor, the Center for the Study of Services (CSS). The purpose of this survey is to assess adequate appointment wait times for our members with an urgent condition or for routine services. The survey will be conducted in the same manner as in the past, and your cooperation is expected and appreciated. Kindly notify office staff of the requirement to participate in this survey.

Keeping your data up to date is a condition of your provider contract with Anthem Blue Cross and Blue Shield (Anthem) and a requirement as part of the Consolidated Appropriations Act (CAA). We ask that you update office information using the PDM application on the Availity Essentials platform and that you participate in quality programs such as this critical survey.

Office information crucial for the survey includes:

• Having correct, working phone numbers.
• Updating information such as when a practitioner has moved, retired, or is deceased.
• Updating if your practice is no longer contracted with Anthem, accepts private pay only, or is no longer in business.

You are also required to provide compliant after-hours, 24/7, urgent care messaging, instructing the caller/patient to hang up and call 911 or go to urgent care or emergency room (ER) or you must directly connect the caller with PCP or on-call physician.

Your contract compels access for all covered members to obtain timely needed appointments. The leading timeframes are below.

The annual behavioral health access studies will see a change in 2024 as a new vendor, Center for the Study of Services (CSS) in Washington, D.C., will be performing the office level survey and making calls during the first through third quarters. The survey will be conducted in the same manner as in the past and your cooperation is expected and appreciated. The purpose is to assess adequate appointment wait times for our members with an urgent condition or for routine services.

Consequently, we ask that you update office information using the PDM application on Availity Essentials or follow processes if assigned to Carelon Behavioral Health, Inc., and that you participate in quality programs, such as this critical survey, as a condition of your contract. The main challenges the vendor encounters are incorrect or non-working phone numbers; practitioner moved, retired, or is deceased; the practice has left their Anthem Blue Cross and Blue Shield (Anthem) contract, accepts private pay only, or is no longer in practice; and staff refusing to participate in the survey. Please take time to update information for each practitioner associated with the practice phone number(s), past or present.

Your contract compels access for all covered individuals to obtain timely needed appointments. The leading timeframes are below. See your Anthem Provider Manual for details. And don’t forget your compliant after-hours emergency or urgent messaging 24/7, by a recording or a live person, instructing the caller/patient to hang up and call 911 or 24-hour crisis services, or go to urgent care or ER; or directly connecting with practitioner or on-call practitioner.

Ohio behavioral healthcare appointment access

We are committed to helping patients more easily access the care they need.

As a reminder, we will update our claim editing software for outpatient facility services throughout 2024, with many updates occurring quarterly. These updates include, but are not limited to:

• The addition of new and revised codes (for example, CPT^®, HCPCS, ICD-10, modifiers, revenue codes) and associated edits.
• Updates related to the appropriate use of various code combinations, including but not limited to, CPT/HCPCS code to revenue code, type of bill to procedure code, type of bill to CPT/HCPCS code, and CPT/HCPCS code to modifier.
• Updates to National Correct Coding Initiative edits (NCCI) and facility outpatient hospital services medically unlikely edits (MUEs).
• Updates to reflect coding requirements as designated by industry standard sources such as the National Uniform Billing Committee (NUBC) and the Centers for Medicare and Medicaid Services (CMS).

As a reminder, we will update our claim editing software for professional services throughout 2024, with most updates occurring quarterly. These updates apply to any provider, provider group (identified by tax identification number), and/or across providers and claim type (such as, professional or facility) and include, but are not limited to:

• The addition of new, and revised codes (for example, CPT^®, HCPCS, ICD-10, modifiers) and associated edits such as:
  • ICD-10 laterality
  • Add-on procedures (indicated by + sign)
  • Code book parenthetical statements and other directives about appropriate code use (for example, separate procedure, do not report, list separately in addition to, etc.)
• Updates to editing for multiple procedure and bilateral reduction calculations based on relative value unit (RVU) as designated and updated by the Centers for Medicare & Medicaid (CMS) in the physician fee schedule relative value (PFSRV) files
• Updates to National Correct Coding Initiative edits (NCCI) and medically unlikely edits (MUEs)
• Updates to incidental, mutually exclusive, and unbundled (re-bundle) edits
• Updates to code edits associated with reimbursement policies including, but not limited to, bundled services, global surgery preoperative, and post-operative periods assigned by CMS, edits that allow/disallow for assistant surgeon/co-surgeon/team surgeon, and frequency edits.

Our utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as the member’s coverage according to their health plan. We do not reward providers or other individuals for issuing denials of coverage, service, or care, nor do we make decisions about hiring, promoting, or terminating these individuals based on the idea or thought that they will deny benefits. In addition, we do not offer financial incentives for UM decision makers to encourage decisions resulting in under-utilization. The Anthem Blue Cross and Blue Shield (Anthem) Medical Policies are available on Anthem’s website at Anthem.com.

You can also request a free copy of our UM criteria from our medical management department, and providers may discuss a UM denial decision with a physician reviewer by calling us at the toll-free numbers listed below. UM criteria are also available on the web. Just go to Anthem.com, and select For Providers > Provider Resources > Policies, Guidelines and Manuals > Select your state > View Medical Policies and Clinical UM Guidelines.

We work with providers to answer questions about the utilization management process and the authorization of care. Here’s how the process works:

• Call us toll free from 8:30 a.m. to 5 p.m. Monday through Friday (except on holidays). More hours may be available in your area. Federal Employee Program^® hours are 8 a.m. to 7 p.m. Eastern.
• Our associates will contact you about your UM inquiries during business hours, unless otherwise agreed upon.

The following phone lines are for physicians and their staff. Members should call the customer service number on their health plan ID card.

For language assistance, members can simply call the Customer Service phone number on the back of their ID card, and a representative will be able to assist them.

Our utilization management associates identify themselves to all callers by first name, title, and our company name when making or returning calls. They can inform you about specific utilization management requirements, operational review procedures, and discuss utilization management decisions with you.

One of the greatest responsibilities Anthem Blue Cross and Blue Shield (Anthem) has to our members is to administer their benefits accurately. We conduct prepay itemized bill reviews for inpatient and outpatient services to ensure member cost shares are correctly applied. We have recently made the determination that our members would be best served if we were to require itemized bills for inpatient services billed in excess of $50,000 and outpatient services billed in excess of $20,000.

On August 1, 2023, we implemented the following change when submitting itemized bills for Anthem inpatient and outpatient member claims for fully insured members only:

• For inpatient services, submit an itemized bill for member claims in excess of $50,000.
• For outpatient services, submit an itemized bill for member claims in excess of $20,000.
• The itemized bill should be equal to the amount billed in order for us to process the claim.

Effective March 1, 2024, this change will also apply ASO (administrative services only) and BlueCard member claims.

We want to reduce the impact to your billing area as much as possible, so we have introduced a process that will:

• Reduce the time needed to identify a fully insured member.
• Eliminate the need to submit itemized bills when not needed.
• Integrate with your existing workflows to enable digital submission.

Anthem’s Digital Request for Additional Information (Digital RFAI) process enables you to submit itemized bills digitally through Availity.com.

The most efficient way to submit itemized bills is through the Digital RFAI process. This is how it works:

1. Register for the Medical Attachments application on Availity.com.

2. Submit your claim through either EDI or the Availity.com Claims & Payments application.
3. If an itemized bill is needed, we send a notification to your Attachments Dashboard on Availity.com each morning by 8 a.m. Eastern.
4. You retrieve the notification and upload the itemized bill directly to your claim as an attachment.

If an itemized bill is not required for the claim, you will not receive a notification, and the claim will continue through processing.

Another benefit of the Digital RFAI process is the claim will pend (rather than deny), allowing up to 30 days for you to supply the requested itemized bill.

Access the Digital RFAI webpage for learning resources, pre-recorded demonstrations, and more:

1. Start by viewing the Digital Request for Additional Information Training session.
2. For help with Availity Medical Attachment setup, access this video for additional instructions.
3. Not registered with Availity Essentials? Here’s a link to get started with Availity.

For more information, contact Availity Essentials Client Services at 800-282-4548 or use this link to take an on-demand Digital RFAI learning session

The National Committee on Quality Assurance (NCQA) has advised Durable Medical Equipment (DME) providers are to be considered within the scope of an entity’s credentialing program for accreditation purposes. Starting February 2024, recredentialing of the existing Durable Medical Equipment Providers and Prosthetic and Orthotic Suppliers (DMEPOS) network will begin. You will receive communication asking you to either complete an application or to supply us with any of the following information:

• Copy of all federal, state, and/or local licenses required to operate as a healthcare facility (by location).

• Copy of accreditation certificate or letters if accredited.
• Copy of most recent CMS or state survey (with deficiencies) including cover letter from CMS or state agency stating facility is in substantial compliance or Corrective Action Plan if deficiencies were cited if not accredited is required.

Please respond to these communications as quickly as possible so no disruption in service to our members or to you occurs. Contact information for questions related to this change will be included in the outreach sent.

Through genuine collaboration, we can simplify access to care and help you deliver high-quality, equitable healthcare. The Credentialing team looks forward to working with you.

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relationship Management representative or refer providers to the number on the back of their patient’s member ID card for Provider Services.

Coordination of care among providers is a vital aspect of good treatment planning to ensure appropriate diagnosis, treatment, and referral. Anthem Blue Cross and Blue Shield (Anthem) would like to take this opportunity to stress the importance of communicating with your patient’s other healthcare practitioners. This includes primary care physicians (PCPs) and medical specialists, as well as behavioral health practitioners (BH).

Coordination of care is especially important for patients with high utilization of general medical services and those referred to a BH specialist by another healthcare practitioner. Anthem urges all of its practitioners to obtain the appropriate permission from these patients to coordinate care between BH and other healthcare practitioners at the time treatment begins. We expect all healthcare practitioners to:

• Discuss with the patient the importance of communicating with other treating practitioners.
• Obtain a signed release from the patient and file a copy in the medical record:
  • Document in the medical record if the patient refuses to sign a release.
• Document in the medical record if you request a consultation.
• If you make a referral, transmit necessary information; and if you are furnishing a referral, report appropriate information back to the referring practitioner.
• Document evidence of clinical feedback (in other words, consultation report) that includes, but is not limited to:
  • Diagnosis
  • Treatment plan
  • Referrals
  • Psychopharmacological medication (as applicable)

To facilitate coordination of care, we have several tools available on our Provider website for BH and other medical practitioners including:

• Coordination of Care Form
• Coordination of Care Letter Template - Behavioral Health
• Coordination of Care Letter Template - Medical

The following behavioral health forms, brochures, and screening tools for substance use and attention-deficit/hyperactivity disorder (ADHD) are also available on our Provider website:

• Alcohol Use Assessment Brochure
• Antidepressant Medication Management
• Edinburgh Postnatal Depression Scale
• Opioid Use Assessment Brochure
• Substance Brief Intervention/Referral Tool (SBIRT)
• Vanderbilt ADHD Diagnostic Parent Rating Scale

Managing any illness can be a difficult thing to do. Knowing who to contact, what test results mean, or how to get needed resources is very important and can be overwhelming.

Anthem Blue Cross and Blue Shield (Anthem) is available to help with our Case Management Program. Our case managers are part of an interdisciplinary team of clinicians and professionals that are here to support members, families, primary care physicians, behavioral health practitioners, and caregivers. The case management process uses the experience and expertise of the care coordination team whose goal is to educate and empower our members to increase self-management skills, understand their illness, and learn about care choices in order to access quality, efficient healthcare.

For physical health services, members or caregivers can refer themselves or family members by calling the number located below. They will be transferred to a team member based on their immediate need. Physicians can also refer their patients by contacting us telephonically or through electronic means. No issue is too big or too small. We can help with transitions across level of care so members and caregivers are better prepared and informed about healthcare decisions and goals.

For BH or substance use disorder services members can contact their health plan to verify benefits and access Anthem.com, or if an FEP member, fepblue.com to search for and access BH providers. It is best to have the member or member’s family contact our department directly to ensure privacy.

How do you contact us?

For commercial and exchange members, the member can contact customer service for assistance.

For FEP members, physical and behavioral health practitioners can refer to Anthem behavioral health case management with member consent by calling 800-711-2225 option 3.

We ask that you review your online provider directory information on a regular basis to ensure it is accurate. Access your information by visiting anthem.com/provider, then select the Find Care button at the top right of the webpage.

Submit updates and corrections to your directory information by following the instructions on our Provider Maintenance webpage. We will send you an email acknowledging receipt of your request. Online update options include:

• Add/change an address location
• Name change
• Phone/fax number change
• Provider leaving a group or a single location
• Closing a practice location

The Consolidated Appropriations Act (CAA) of 2021 contains a provision that requires online provider directory information be reviewed and updated as needed at least every 90 days. Reviewing your information on a regular basis is the best way to help ensure your online provider directory information is current.

With your help, we can continually build towards a future of shared success.

As part of our commitment to provide you with the latest clinical information and educational materials, we have adopted nationally recognized medical, behavioral health and preventive health guidelines, which are available to providers on our website. The guidelines, which are used for our quality programs, are based on reasonable medical evidence, and are reviewed for content accuracy, current primary sources, the newest technological advances, and recent medical research.

All guidelines are reviewed annually and updated as needed. The current guidelines are available on our website at https://www.anthem.com/provider/ and select Change State >Provider > Select Policies, Guidelines & Manuals under Provider Resources> scroll down and select Clinical Practice Guidelines or Preventive Health Guidelines.

If you have questions, please contact the number on the back of the member ID card for Provider Services.

The delivery of quality healthcare requires cooperation between patients, their providers, and their healthcare benefit plans. One of the first steps is for patients and providers to understand their rights and responsibilities. Therefore, in line with our commitment to involve the health plan, participating practitioners, and members in our system, Anthem Blue Cross and Blue Shield has adopted a Members’ Rights and Responsibilities statement.

This statement can be found on our website under the FAQ question about Laws and Rights that Protect You. To access the statement, visit anthem.com and select Provider. From there, select Policies, Guidelines & Manuals under Provider Resources. Select your state and scroll down to Member Rights and Responsibilities under More Resources. Then select the Read about member rights link. For federal employees, practitioners may access the FEP member portal at www.fepblue.org/memberrights to view the FEPDO Member Rights Statement.

As a contracted provider for special needs plan (SNP) from Anthem Blue Cross (Anthem), you are required to participate in an annual model of care training for providers per CMS regulations. This training includes a detailed overview of Anthem special needs plans and program information — highlighting cost sharing, data sharing, participation in the Interdisciplinary Care team (ICT), where to access the member’s health risk assessment results, plan of care, and benefit coordination. Please remember this training is specific to our plans and delivery of care for members ensuring their specific care needs are met. Your participation is critical for improved quality and health outcomes.

Training for SNP product for Anthem is self-paced and available at availity.com.

The training must be completed by December 31, 2023.

How to access the Custom Learning Center on the Availity Essentials website:

1. Log in to Availity Essentials website at availity.com:
   • At the top of Availity Essentials website, select Payer Spaces and select the appropriate payer.
2. On the Payer Spaces landing page, select Access Your Custom Learning Center from Applications.
3. In the Custom Learning Center, select Required Training.
4. Select Special Needs Plan and Model of Care Overview.
5. Select Enroll.
6. Select Start.
7. Once the course is completed, select Begin Attestation and complete.

Not registered for Availity Essentials?

Have your organization’s designated administrator register your organization for the Availity Essentials website:

1. Visit availity.com to register.
2. Select Register.
3. Select your organization type.
4. In the Registration wizard, follow the prompts to complete the registration for your organization.

Refer to these PDF documents: https://apps.availity.com/availity/Demos/Registration/index.htm for complete registration instructions.

Anthem Blue Cross and Blue Shield (Anthem) is excited to announce a new High Performing Provider (HPP) designation to care providers meeting certain cost and quality metrics. Through this new designation, Anthem is expanding our consumer tools and content to assist members in making more informed and personalized healthcare decisions. Initially, the designation will focus on certain types of professional providers, but it may be broadened to include other care provider types in the future.

The High Performing Provider designation will launch on January 1, 2024.

Anthem may highlight HPPs in various ways, including, but not limited to:

• Special opportunities to participate in product offerings.
• When members contact Anthem with requests for referral options.
• Placing a designation in Anthem’s Care and Cost Finder. This would be in addition to Anthem’s existing tool in Care and Cost Finder called Personalized Match that provides Anthem members with the option to search for in-network care providers through a specialized sorting tool that considers certain cost and quality metrics, as well.

For more information on the HPP designation, you can view the designation methodology, or to know if your practice will receive the designation, send an email to HPPdesignation@anthem.com.

HEDIS^® measure data is collected by one or more methods:

• Administrative method — claims and supplemental data
• Hybrid method — administrative and medical record data
• Survey method — Health Outcomes Survey(HOS) & Consumer Assessment of Healthcare Providers & Systems (CAHPS^®)
• Electronic Clinical Data Systems (ECDS) — HEDIS reporting standard that leverages electronic data from multiple sources. See below.

The HEDIS Electronic Clinical Data Systems (ECDS) Reporting Standard was introduced in HEDIS 2016 (measurement year 2015) by the National Committee of Quality Assurance (NCQA) and encourages health information exchange, which is the secure sharing of patient medical information electronically. ECDS data collection is part of NCQA’s nationwide plan to capture information regarding aspects of care quality with less reliance on clinical medical record review.

There are four types of ECDS:

1. Electronic Health Record (EHR)/Personal Health Record (PHR): Real-time, patient-centered records that make information available instantly and securely to authorized users. EHRs eligible for this category of ECDS reporting include the NCQA eMeasure certification program or any system that meets the 2015 Edition Base Electronic Health Record (EHR) definition.
2. Health Information Exchange (HIE)/Clinical Registry: HIEs and clinical registries eligible for this reporting category include state HIEs, immunization information systems (IIS), public health agency systems, regional HIEs (RHIO), Patient-Centered Data Homes™ or other registries developed for research or to support quality improvement and patient safety initiatives. Doctors, nurses, pharmacists, other health care providers and patients can use HIEs to access and share vital medical information, with the goal of creating a complete patient record. Clinical registries can be sponsored by a government agency, nonprofit organization, health care facility or private company, and decisions regarding use of the data in the registry are the responsibility of the registry’s governing committee.
3. Case Management System: A shared database of member information collected through a collaborative process of member assessment, care planning, care coordination or monitoring of a member’s functional status and care experience. Case management systems eligible for this category of ECDS reporting include any system developed to support the organization’s case/disease management activities, including activities performed by delegates.
4. Administrative: Includes data from administrative claim processing systems for all services incurred (in other words, paid, suspended, pending and denied) during the period defined by each measure’s participation as well as member management files, member eligibility and enrollment files, electronic member rosters, internal audit files, and member call service databases.

Having more time to focus on patient care rather than responding to medical record requests is possible by participating in Electronic Clinical Data Systems (ECDS). We are focused on reducing administrative burdens, so you can do what you do best – care for our members. Let us help by granting EMR Direct Remote access to our EMR team.

Need more information or ready to sign up?

Please email us today at: Centralized_EMR_Team@unicare.com.

HEDIS^® measure data is collected by one or more methods:

• Administrative method — claims and supplemental data
• Hybrid method — administrative and medical record data
• Survey method — Health Outcomes Survey(HOS) & Consumer Assessment of Healthcare Providers & Systems (CAHPS^®)
• Electronic Clinical Data Systems (ECDS) — HEDIS reporting standard that leverages electronic data from multiple sources. See below.

The HEDIS Electronic Clinical Data Systems (ECDS) Reporting Standard was introduced in HEDIS 2016 (measurement year 2015) by the National Committee of Quality Assurance (NCQA) and encourages health information exchange, which is the secure sharing of patient medical information electronically. ECDS data collection is part of NCQA’s nationwide plan to capture information regarding aspects of care quality with less reliance on clinical medical record review.

There are four types of ECDS:

1. Electronic Health Record (EHR)/Personal Health Record (PHR): Real-time, patient-centered records that make information available instantly and securely to authorized users. EHRs eligible for this category of ECDS reporting include the NCQA eMeasure certification program or any system that meets the 2015 Edition Base Electronic Health Record (EHR) definition.
2. Health Information Exchange (HIE)/Clinical Registry: HIEs and clinical registries eligible for this reporting category include state HIEs, immunization information systems (IIS), public health agency systems, regional HIEs (RHIO), Patient-Centered Data Homes™ or other registries developed for research or to support quality improvement and patient safety initiatives. Doctors, nurses, pharmacists, other health care providers and patients can use HIEs to access and share vital medical information, with the goal of creating a complete patient record. Clinical registries can be sponsored by a government agency, nonprofit organization, health care facility or private company, and decisions regarding use of the data in the registry are the responsibility of the registry’s governing committee.
3. Case Management System: A shared database of member information collected through a collaborative process of member assessment, care planning, care coordination or monitoring of a member’s functional status and care experience. Case management systems eligible for this category of ECDS reporting include any system developed to support the organization’s case/disease management activities, including activities performed by delegates.
4. Administrative: Includes data from administrative claim processing systems for all services incurred (in other words, paid, suspended, pending and denied) during the period defined by each measure’s participation as well as member management files, member eligibility and enrollment files, electronic member rosters, internal audit files, and member call service databases.

Having more time to focus on patient care rather than responding to medical record requests is possible by participating in Electronic Clinical Data Systems (ECDS). We are focused on reducing administrative burdens, so you can do what you do best – care for our members. Let us help by granting EMR Direct Remote access to our EMR team.

Need more information or ready to sign up?

Please email us today at: Centralized_EMR_Team@unicare.com.

Anthem Blue Cross and Blue Shield (Anthem) has processes in place for our members under the age of 21 years old to ensure care that prevents, detects, and treats medical, social, educational, and other needs identified for our members. This care falls under our Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) coverage. This program follows state guidelines of what care is recommended by age for eligible members to receive medical care, dental care, health screenings, mental health screenings, and social needs assessments and interventions.

The EPSDT program uses internal reports to identify eligible members that are under 21 years of age. These reports identify members who are compliant with appropriate age care and those who have identified gaps in care. Anthem sends reminders to members for needed care and services offered, like transportation, to help the families and members who need connection to care.

What does that mean for you as a care provider?

Anthem will help connect members to you! We cover all the necessary appointments and needs for our members to keep wellness at the forefront for them and help break down barriers they face when getting the care they need. Anthem will use the data collected for our members and help direct them to you based on geographic location, care needs by age, and specialty. Anthem sends reminders, campaign information, and outreaches to members based on their preferences by text or email.

For care providers who are part of our comprehensive maternal care (CMC), comprehensive primary care (CPC), and/or OhioRISE programs, we can help you set up access with direct communication through our care coordination portal (CCP) to make it easier with data sharing and digital communication. You can access this through the Care360 portal. If you do not have access, select the Go To OH|ID button to create an account. There are resources available for login help.

We look forward to partnering with you. Anthem strives to be the bridge between the member and you, as their care provider. For general concerns, contact Member Services at 844-912-0938, or call 844-912-1226 for authorizations, claims, or any other billing needs.