Early intervention claims

The Department of Medical Assistance Services has asked us to implement some changes to Anthem HealthKeepers Plus claims payment requirements for certain early intervention (EI) claims. 

 

Effective January 1, 2019, HealthKeepers, Inc. will implement claims edits that will impact claims payments for EI claims if an Individual Family Service Plan (IFSP) is not on file with HealthKeepers, Inc. prior to submitting claims.

 

Please review the following information on the new EI claims payment requirements:

 

• We still do not require authorizations for EI services. 
• However, we now require an IFSP to be on file to serve as a notification authorization.
• Claims will only pay when an IFSP is on file and the services billed align with the services listed on the IFSP.
• Clean claims are processed within 14 days. If an IFSP is not on file, the claim will not be considered clean.
• Codes T2022 and T1023 do not require an IFSP, as these are for service coordination and assessment; these claims will not be impacted.
• All other codes require an IFSP to be on file with HealthKeepers, Inc.
• All revisions to an IFSP should be submitted directly to HealthKeepers, Inc. as soon as possible via fax to 1-866-920-4097 or email  to: wrkgp-EarlyInterventionServicesSupport@anthem.com.
• For issues pertaining to EI claims, please call Provider Services at 1-800-901-0020 or call the Anthem CCC Plus team at 1-855-323-4687.
• The Virginia Department of Behavioral Health and Developmental Services must certify servicing providers.

 

Note: Please contact your Anthem HealthKeepers Plus patient’s care coordinator to ensure that your patient’s IFSP is on file.