New guideline for electronic medical record; clinical data sharing; and admission, discharge, and transfer notifications

Effective July 1, 2023, Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. are implementing a new guideline related to submission of certain clinical data that builds upon our 2021 guideline regarding sharing of admission, discharge, and transfer (ADT) notifications.

When requested by Anthem, providers shall submit clinical data (such as discharge summaries, consult notes, and medication lists) and ADT data to Anthem for certain healthcare operations functions. We collect this data to improve the quality and efficiency of healthcare delivery to our members. Providers shall submit:

• ADT data to Anthem or state-designated Health Information Exchange on a near real-time basis (no later than 24 hours) from time of admission, discharge, or transfer of a member.
• Clinical data for a member on a daily, weekly, or monthly basis, based on the provider's electronic medical record (EMR) or other electronic data sharing capabilities.

Anthem permitted uses of the data with respect to clinical data requests include:

• Utilization management.
• Case management.
• Identification of gaps in care.
• Conducting clinical quality improvement.
• Risk adjustment.
• Documentation in support of HEDIS^® and other regulatory and accrediting reporting requirements, and for any other purpose permitted under HIPAA.

Anthem has determined the data requested is the minimum necessary for Anthem to accomplish our intended purpose. The data will be provided in accordance with data layout and format requirements defined by Anthem. 

We value you as our partner in providing quality care and appreciate your continued participation in our networks.