2019 Program year progression:  What's in it for you and your patients?

Continuing our 2019 Commercial Risk Adjustment (CRA) reporting updates, Anthem Blue Cross and Blue Shield requests your assistance with respect to our CRA reporting processes.


As we reported in the May and June newsletters, we are completing our prospective and retrospective reviews for 2019.  Prospectively, we intervene to encourage the participation of the members we have identified as appropriate for clinical assessments.  Retrospectively, certified coders review medical charts to determine if there are diagnosis codes that have not been reported.


What’s in it for you?


First, monthly you will receive lists of our members who are your patients to help you reach out to those who may have gaps in care, so they can come in for office visits earlier.


Second, we’ve heard resoundingly from providers that participation in these programs helps them better evaluate their patients (who are our members) and, as a result, perform more strongly in population health management and gain sharing programs. Many cite that they ask different questions today that allow them to better manage their patients’ overall health.


Finally, when you see Anthem members and submit assessments, we pay incentives of $100 for an electronic submission and $50 for a paper submission. For additional details on how to earn these incentives and the options available, please contact our CRA network education representative listed below.   


What’s in it for your patients?


Anthem has completed monthly postcard campaigns with messaging to encourage members with Affordable Care Act (ACA) compliant coverage to call their primary care providers (PCPs) to schedule annual checkups when we suspect high risk conditions.  The goal is to get the members in to see their PCPs, so the PCPs have an overall picture of their patients’ health and schedule any screenings that may be needed. 

We will continue these monthly postcard mailings throughout 2019 to encourage members to be seen in your office, which supplements any patient outreach you may be doing as well.


If you have any questions regarding our reporting processes, please contact our CRA network education representative:


Featured In:
July 2019 Anthem Provider News - Virginia