Essential information for providers: understanding Medicare Advantage group retiree plans

Anthem’s Group Medicare Advantage (MA) plans serve as a comprehensive alternative to Original Medicare (Parts A and B), providing additional benefits such as routine physicals, hearing aids, vision care, chiropractic services, acupuncture, LiveHealth Online, and SilverSneakers^®.

Key highlights for providers

Network flexibility

Providers do not need to be part of Anthem's network to serve members of the Group Retiree Medicare Advantage PPO plans. Services are accessible from any Medicare‑approved provider, offering flexibility in care delivery.

Value‑based partnerships

Anthem offers collaboration through value‑based and population health management programs, aligning with healthcare goals focused on quality outcomes and patient satisfaction. These programs are available to contracted providers.

Reimbursement and claims:

• Out‑of‑network reimbursement: Providers receive Medicare allowable rates, minus copayments or coinsurance.
• Claims submission: Submit claims electronically via the Availity Essentials website or by mail using local Blue plan instructions.

Access and authorizations:

• Streamlined access: No referrals are needed for members.
• Prior authorization (PA): Required for contracted providers; recommended for non‑contracted providers

Provider resources

Providers can use the following resources to ensure smooth delivery of services:

• Join our network: Guidance is available at www.anthem.com/provider/getting-started.
• Verify eligibility and benefits, and request prior authorization: Providers can check through:
• Online: https://Availity.com
• Phone: Call 833‑848‑8730.

By understanding these aspects, providers can efficiently navigate Anthem Group Medicare Advantage plans, ensuring optimal service delivery to patients while fostering valuable professional partnerships.