Commonwealth of Virginia (COVA) and The Local Choice (TLC) employees who participate in Anthem health care plans are being issued new, revised member identification cards over the next several months. The revised cards include a new ID number prefix and, for TLC members, a new group number, both of which are effective on the dates outlined in the table below. Line of Duty Act (LODA) health plan prefixes are NOT changing. 

Request current ID cards at time of service

While members have been instructed to present their new ID cards to health care providers when seeking covered services beginning July 1 or risk potential denial of claims, your office, practice or facility should always request that patients present their most current ID cards at the time of service. When filing claims to Anthem and affiliate HealthKeepers, Inc., enter the ID numbers exactly as they appear on the card – including the ID number prefix – to help speed claims processing and reimbursement.

It’s important that providers update each patient’s health insurance and billing information with the new prefix and group numbers displayed on members’ ID cards and use this updated information when filing claims to Anthem.

Electronic ID cards

Our Provider News is our primary source for providing important information to health care providers and professionals. Provider News is published monthly and is posted to our website on the Virginia provider section of anthem.com for easy 24/7 access.

Note that in addition we also use our email service to communicate new information. If you are not yet signed up to receive these notices, we encourage you to enroll now so you’ll be sure to receive all information we will be sending about billing, upcoming changes, coverage guidelines and other pertinent topics.

Reminder notifications sent via email

When you sign up, you’ll not only receive an email reminder for each Provider News posted online, you’ll  also be notified of other late breaking news and important information you’ll need when providing services and filing claims for our members. It’s easy to register.

On October 10, 2019, Anthem will offer our last provider education webinar for the year. Designed for our network-participating providers, the webinars address Anthem business updates and billing guidelines that impact your business interactions with us.

For your convenience, we offer these informative, hourly sessions online to eliminate travel time and help minimize disruptions to your office or practice. The date for the fall webinar is:

• Thursday, October 10, 2019, from 11:30 a.m. to 12:30 p.m. ET

Please take time to register today for the webinar using the registration form to the right under the “Article Attachments” section. If you have already registered for the October webinar, please ensure you have received a fax confirmation or a confirmation from an Anthem representative to ensure we’ve received your registration form.  Contact stacey.marsh@anthem.com if you need to confirm your registration.

Anthem Blue Cross and Blue Shield respects your time, and we want your service experience to be exceptional.  As a reminder, effective June 13, 2019, you may have noticed slight changes to the prompts within our interactive voice response (IVR) system when you dial Anthem’s Provider Service areas.  These enhancements were designed to make it easier for you to get the information you need quickly when you call and to streamline your call-in experience – saving you time in the process.   

IMPORTANT:  Always refer to the back of members’ health insurance ID cards for the most accurate Provider Services telephone number.  This will help prevent unnecessary misroutes or delays. The back of the member’s ID card (text at the bottom) will also identify the Home Plan issuing the member’s policy.

If you do not have the member’s ID card available, please refer to the following as general guidance:

Sample ID card below showing where the Plan code on the member’s ID card can be found.

NOTE: 

Please make sure you are checking the member’s ID card for the Plan code.

Beginning with dates of service on or after November 1, 2019, new Interprofessional CPT codes 99451 and 99452 are not eligible for reimbursement when they are reported with another service or reported as a stand-alone service. These codes have been added to policy section 1 of the Bundled Services and Supplies reimbursement policy.

As a result of coding updates in the claims systems, certain claim system edits for reimbursement policies will be implemented on or after September 1, 2019.  All of these reimbursement policies have been disclosed in the Virginia Provider Agreements since 2017, but have not been applied in all claims platforms due to system constraints that existed until now.

As a reminder, Fee Schedule information is confidential and proprietary to Anthem Blue Cross and Blue Shield and affiliate HealthKeepers, Inc. in your Provider Agreement (the “Agreement”). The Agreement has general restrictions regarding disclosure of fee schedule and other confidential information. For example, neither Anthem nor the Provider may disclose confidential and proprietary information except:

1) As required by Regulatory Requirements;

2) Upon the express written consent of the parties;

3) As required to perform the obligations of the Agreement; or

4) As required to deliver Health Services or administer a Health Benefit Plan.

Please refer to your specific Agreement for a complete list of disclosure restrictions.  Anthem provider agreements allow the disclosure of confidential information, including Fee Schedule information, to specified third-parties (such as consultants, lenders, legal advisors, and business advisors) as long as those parties keep the information confidential.   Be aware that if you retain a third party and disclose Anthem’s confidential information to them as permitted, and that third party fails to keep Anthem’s information confidential, you may be held responsible for the confidentiality breach.

Anthem Blue Cross and Blue Shield has launched a new page on anthem.com to access our Provider Manuals.  This page delivers a more streamlined and easier user experience to access current and past Manuals (if applicable).   

To view the new page, go to:  anthem.com │Provider │ Provide Overview │ select Your State │Scroll down to “Enjoy Easy Access to Policies and Guidelines,” and select “See Policies and Guidelines.”  From the Policies and Guidelines landing page, there is a link to Download the Manual, as well as access previous versions and other manuals applicable to your state.

Effective for dates of service on and after November 10, 2019, the following updates will apply to the AIM Radiation Oncology: Proton Beam Therapy Clinical Appropriateness Guideline.

• Sinonasal cancer: Added criteria and diagnosis codes for locally advanced sinonasal cancer when tumor involves base of skull and proton beam therapy is needed to spare orbit, optic nerve, optic chiasm, or brainstem

• Ocular Melanoma: Removed tumor size restrictions for treating melanoma of the uveal tract

• Pediatric tumors: Clarified proton beam therapy appropriate for all pediatric tumors requiring radiation therapy

• Access AIM’s ProviderPortal_SM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.

• Access AIM via the Availity Web Portal at availity.com.

• Call the AIM Contact Center toll-free number: 866-789-0397, Monday - Friday, 8 a.m. to 5 p.m. ET.

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines.

Effective for dates of service on and after July 14, 2019, the following updates will apply to the AIM Advanced Oncologic Imaging Clinical Appropriateness Guideline.

Prostate Cancer

Added criteria for the appropriate use of PET-CT with the radiotracers Axumin and 11-Choline, establishing the position of this test in the care continuum for prostate cancer primarily related to biochemical recurrence

Neuroendocrine Tumors

Added criteria for the appropriate use of PET-CT with the radiotracer DOTA-TATE  establishing the position of this test in the care continuum for neuroendocrine tumors

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:

• Access AIM’s ProviderPortal_SM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.

• Access AIM via the Availity Web Portal at availity.com.

• Call the AIM Contact Center toll-free number:  866-789-0397, Monday - Friday, 8 a.m. to 5 p.m. ET

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current guidelines.

Effective for dates of service on and after November 10, 2019, the following updates will apply to the AIM Advanced Imaging Clinical Appropriateness Guidelines.

Oncologic Imaging Guideline contains updates to the following:

• Colorectal cancer, germ cell tumors, kidney cancer, multiple myeloma, prostate cancer and cancers of unknown primary / cancers not otherwise specified,

• Added new sections on hepatobiliary cancer and suspected metastases

• Added allowance for MRI and/or MRCP for diagnostic workup of hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and extrahepatic cholangiocarcinoma

• Added allowance for PET “When standard imaging prior to planned curative surgery for cholangiocarcinoma has been performed and has not demonstrated metastatic disease”

Vascular Imaging Guideline contains updates to the following:

• Brain, Head and Neck: Aneurysm - intracranial,  Aneurysm - extracranial, Arteriovenous malformation (AVM) and fistula (AVF), Fibromuscular dysplasia, Hemorrhage - intracranial, Stenosis or occlusion -  extracranial, Stenosis or occlusion -  intracranial, stroke and Venous thrombosis or compression -  intracranial

• Chest: Acute aortic syndrome, Aortic aneurysm, Pulmonary artery hypertension

• Abdomen and Pelvis: Acute aortic syndrome, Aneurysm of the abdominal aorta or iliac arteries, Hematoma/hemorrhage within the abdomen or unexplained hypotension, Renal artery stenosis (RAS)/Renovascular hypertension, Venous thrombosis or compression – intracranial, Stenosis or occlusion of the abdominal aorta or branch vessels, not otherwise specified

• Upper Extremity: Peripheral arterial disease, Venous thrombosis or occlusion

• Lower Extremity: Added physiologic testing for peripheral arterial disease and further defined indications for classic presenting symptoms of lower extremity peripheral arterial disease

• Added arterial ultrasound guideline content

• Aligned peripheral arterial ultrasound with advanced vascular imaging criteria

Imaging of the Heart Guideline contains updates to the following:

• Blood Pool Imaging: Changes address appropriate evaluation and surveillance of LV function in patients following cardiac transplantation. Additional language is more restrictive based on the literature and aligns with the resting transthoracic echocardiography guideline.

• Cardiac CT: Quantitative evaluation of coronary artery calcification has been revised with new more expansive language based on review of the literature.

• Access AIM’s ProviderPortal_sm directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.

• Access AIM via the Availity Web Portal at availity.com.

• Call the AIM Contact Center toll-free number:  866-789-0397, Monday - Friday, 8 a.m. to 5 p.m. ET

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com.  Additionally, you may access and download a copy of the current guidelines.

Effective November 1, 2019, the following MCG care guideline 23rd edition customization will be implemented for Chemotherapy, Inpatient and Surgical Care (W0162) for adult patients. This customization provides specific criteria and guidance on the following:

• Revised Clinical Indications for admission and added examples for:

1. Aggressive hydration needs that cannot be managed in an infusion center
2. Prolonged marrow suppression

• Added Regimens that cannot be managed as an outpatient with examples

Select MCG 23RD edition customizations to view a summary. 

For questions, please contact the provider service number on the back of the member's ID card.

As we continue our commercial risk adjustment efforts to help ensure our members enrolled in Affordable Care Act (ACA) plans have their chronic conditions assessed and documented each year, Anthem Blue Cross and Blue Shield and affiliate HealthKeepers, Inc. are once again engaging Matrix to help encourage members – on our behalf – to schedule an in-home or mobile health clinic assessment.  A vendor, Matrix operates the largest fleet of mobile medical centers nationwide and has conducted more than 1,000,000 patient assessments since 1998 – providing convenient access to comprehensive health assessments. 

The mobile clinic provides members with additional options to help close gaps in care.  In late July, Matrix began reaching out to targeted members on our behalf by letter and phone. Our outreach efforts will continue until the end of this year.

Matrix works with hospitals and health plans like Anthem and HealthKeepers, Inc. to deliver preventive health testing to the communities Matrix serves.  Each mobile clinic has a reception area and private screening rooms.  Matrix also helps members with scheduling follow-up appointments with their PCPs at the end of the assessments, as well as forwarding PCPs a copy of an assessment.

New for this year, Matrix will also perform in-home assessments where possible.  A copy of the assessment will be sent to members’ PCPs to ensure continuity of care.

Members will receive a $50 Visa gift card for completing the mobile or in-home assessment.  They do not have to pay anything for the assessment.

The overall goal of the mobile clinic program is to provide a convenient, comprehensive appointment that is designed to complement the care provided by our network-contracting physicians.  These mobile clinic or in-home visits do not replace any active treatment plans members currently have with their regular physicians and are not considered wellness visits or a substitute for members’ annual physical examinations. 

We’re including information in this edition of Provider News should patients contact you about the program.  Please refer members directly to Matrix if they have questions or need more information:

Mobile Bus: 888-822-3247

In-Home: 855-403-0967

Please continue to check Important Medicare Advantage Updates at anthem.com/medicareprovider for the latest Medicare Advantage information, including:

• Level of E&M Services Reimbursement Policy update

  501146MUPENMUB

• Prepayment clinical validation review process

 501184MUPENMUB

• Unspecified diagnosis code update

 500834MUPENMUB

• Notice of change in Medicare Advantage non-PCP reimbursement status

• Hearing Care Solutions now serves individual Medicare Advantage members in CT, NY, VA and all Group Retiree Solutions members

• Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ

• Group Retiree members and National Access Plus

75743MUPENMUB

Category:  Medicare

Anthem Blue Cross and Blue Shield offers special needs plans (SNPs) to people eligible for either Medicare and Medicaid benefits or who are qualified Medicare Advantage beneficiaries. SNPs provide enhanced benefits to people eligible for both Medicare and Medicaid. These include supplemental benefits such as hearing, dental, vision and transportation to medical appointments. Some SNPs include a card or catalog for purchasing over-the-counter items. SNPs do not charge premiums. As you are aware, CMS regulations protect SNP members from balance billing.

Providers who are contracted for SNPs are required to take annual training to stay current on plan benefits and requirements, including coordination-of-care and model-of-care elements. Providers contracted for our SNPs received notices in the first quarter of 2019 containing information for online, self-paced training through our training site hosted by SkillSoft. Each provider contracted for our SNPs is required to complete this annual training and select the attestation stating they have completed the training. Attestations can be completed by individual providers or at the group level with one signature.

75429MUSENMUB

Category:  Medicare

Currently, providers submit various pre-service requests to AIM Specialty Health® (AIM). As part of our ongoing quality improvement efforts for outpatient diagnostic imaging services, cardiac procedures and sleep studies, AIM may request documentation to support the clinical appropriateness of certain requests.

When requested, providers should verify information by submitting documentation from the medical record and/or participating in a pre-service consultation with an AIM physician reviewer. If medical necessity is not supported, the request may be denied as not medically necessary.

Should you have any questions, please call the Provider Services number on the back of the member ID card.

501337MUPENMUB
Category:  Medicare

Enhancements have been made to the Availity Portal that will now allow you to access more service types when using the Eligibility and Benefits Inquiry tool and will also allow us to share even more valuable information with you electronically.

You may have already noticed new additions to service types, including:

• Medically related transportation

• Long-term care

• Acupuncture

• Respite care

• Dermatology

• Sleep study therapy (found under diagnostic medical)

• Allergy testing

Note, although there is an extensive list of available benefit types available when submitting an eligibility and benefits request, these types do vary by payer. 

Here are some important points to remember when selecting service types:

• The benefit/service type field is populated with the last benefit type you selected. If you don’t see a specific benefit in the results, submit a new request and select the specific benefit type/service code.

• You have the ability to inquire about 50 patients at one time using the Add Multiple Patients feature.

501372MUPENMUB
Category:  Medicare

Drug screen testing

(Policy 19-001, effective 10/01/2019)

Anthem Blue Cross and Blue Shield (Anthem) Medicare Advantage allows reimbursement for presumptive and definitive drug screening services. In certain circumstances, Anthem Medicare Advantage allows reimbursement for presumptive drug testing by instrumented chemistry analyzers and definitive drug screening services for the same member provided on the same day by a reference laboratory.

Definitive drug testing may be done to confirm the results of a negative presumptive test or to identify substances when there is no presumptive test available. Provider’s documentation and member’s medical records should reflect that the test was properly ordered and support that the order was based on the result of the presumptive test.

In the event a reference lab (POS = 81) performs both presumptive and definitive tests on the same date of service, records should reflect that the ordering/treating provider issued a subsequent order for definitive testing based on the results of the presumptive tests.

For additional information, refer to the Drug Screen Testing reimbursement policy at www.anthem.com/medicareprovider.

501120MUPENMUB
Category:  Medicare

Please continue to check our website https://mediproviders.anthem.com for the latest Medicaid information for members enrolled in HealthKeepers, Inc.’s Anthem HealthKeepers Plus and the Commonwealth Coordinated Care Plus (Anthem CCC Plus) benefit plans. Here are some topics we’re addressing in this edition:

• Taxonomy codes

• Prepayment clinical validation review process

• New Reimbursement Policy: Drug Screen Testing

• Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy

• January 2019 Medical Policies and Clinical Utilization Management Guidelines Update

HealthKeepers, Inc. is conducting a survey to gauge your satisfaction with the Anthem HealthKeepers Plus provider services we offer. We will randomly select a number of providers to take part in this process. Selected providers will receive a questionnaire in the mail from SPH Analytics, an independent research firm.

What happens when providers receive the survey?

When you receive the survey, we would greatly appreciate your participation. The survey should take about 15 minutes to complete, and the answers collected will help improve the services we currently provide, and ultimately create a more collaborative partnership with the end goal of providing the highest quality care to our members, your patients.

We thank you in advance for your participation.  If you have any questions about this communication, call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.

We continually update our provider directories to ensure that your current practice information is available to our Anthem HealthKeepers Plus members. At least 30 days prior to making any changes to your practice — including updating your address and/or phone number, adding or deleting a physician from your practice, closing your practice to new patients, etc. — please notify us by completing the Provider Maintenance Form available at https://mediproviders.anthem.com/va. Thank you for your help and continued efforts in keeping our records up to date.

Need up-to-date pharmacy information?

Log in to our provider website (https://mediproviders.anthem.com/va) to access our Formulary, Prior Authorization form, Preferred Drug List and process information.

Have questions about the Formulary or need a paper copy?

Call our Pharmacy department at 1-800-901-0020 for Anthem HealthKeepers Plus members or 1-855-323-4687 for Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) members. Pharmacy technicians are available Monday through Friday from 8 a.m. to 8 p.m.

Our Member Services representatives serve as advocates for our members. To reach Member Services, please call 1-800-901-0020.

This article serves as a reminder to Anthem HealthKeepers Plus providers about policies and procedures regarding claims payment disputes. The following information is included in the Anthem HealthKeepers Plus Provider Manual found at https://mediproviders.anthem.com/va > Manuals, Directories, Training & More > Anthem HealthKeepers Plus Manuals, Directories, Training & Resources.

Provider reconsiderations (first-level appeals)

For questions regarding the outcome of a claim not related to additional authorized days or services, providers may request a reconsideration by calling Provider Services or submitting a Claim Information/Adjustment Request 151 Form. Examples of reconsiderations include claim processing errors or responses to additional information requested. HealthKeepers, Inc. will respond to all reconsideration requests within 60 calendar days.

• Reconsiderations will not be considered if received 12 or more months after the date of the claim adjudication or the EOP. There is no limit to the number of reconsiderations that can be submitted for the same claim within the 12-month period prior to submitting a formal (second-level) appeal; however, once a formal appeal is submitted, no additional reconsiderations can be submitted for that claim.

• Requests to review a finalized claim denied as not medically necessary or experimental/investigational must be submitted as a medical necessity appeal to be considered.

• Requests to review a finalized claim that may require additional authorized days or services must be submitted as a claims payment appeal (see below).

• Adjustments made to finalized claims must be submitted as corrected claims (see below).

Verbal reconsiderations

To submit a verbal reconsideration, call Provider Services at 1‑800‑901-0020 or Anthem CCC Plus Provider Services at 1-855-323-4687, Monday to Friday, 8 a.m. to 6 p.m. ET.

Written reconsiderations

To submit a written reconsideration, use a blank Claim Information/Adjustment Request 151 Form, available online at https://mediproviders.anthem.com/va > Claims > Forms.

Once the form is complete, attach any necessary information and mail it to:

HealthKeepers, Inc.

Reconsiderations

P.O. Box 62404

Virginia Beach, VA 23466-2404

Electronic reconsiderations

To submit an electronic reconsideration, go to https://www.availity.com and:

• Select Claims & Payment/Claims Status Inquiry.

• Fill in the required fields — for details on claims inquiry, search claim inquiry within Availity Help — and navigate to the Claims Detail page.

• Go to the bottom of the claims detail and select Request an appeal for this claim/Dispute the Claim.

• Select I Agree.

If submitted within one year from the date of the EOP, the submission will be treated as a reconsideration. The provider can attach a Claim Information/Adjustment Request 151 Form, but it is not required. If the submission is within one year of the date of the EOP and the provider wishes for HealthKeepers, Inc. to treat the submission as an official appeal, the provider should indicate in the text box provided that the submission should be treated as an appeal and not a reconsideration.

For additional assistance, call Provider Services at 1‑800‑901-0020 or Anthem CCC Plus Provider Services at 1-855-323-4687, Monday to Friday, 8 a.m. to 6 p.m. ET.

Claims payment appeals (second-level appeals)

A claims payment appeal may be requested when:

• A provider disagrees with the determination of a reconsideration.

• A provider is requesting additional days or services to be authorized for a paid claim.

An appeal request must be received within 15 months of the date of service or 180 calendar days of the date a provider is notified of the adverse coverage decision, whichever is later. A claims payment appeal must be submitted in writing or through the Availity Portal.

Written appeals

All claims payment appeals submitted in writing must clearly state that the provider is formally appealing the adverse decision. In order to ensure it is treated as a formal appeal, the provider must indicate that the appeal should not be treated as a reconsideration. Mail written appeal requests to:

HealthKeepers, Inc.

Payment Appeals Unit

P.O. Box 61599

Virginia Beach, VA 23466-1599

Electronic appeals

To submit an electronic appeal, go to https://www.availity.com and:

• Select Claims & Payment/Claims Status Inquiry.

• Fill in the required fields — for details on claims inquiry, search claim inquiry within Availity Help — and navigate to the Claims Detail page.

• Go to the bottom of the claims detail and select Request an appeal for this claim/Dispute the Claim.

• Select I Agree.

For additional assistance, call Provider Services at 1‑800‑901-0020 or Anthem CCC Plus Provider Services at 1-855-323-4687, Monday to Friday, 8 a.m. to 6 p.m. ET.

Process and resolution

HealthKeepers, Inc. will respond to all claims payment appeal requests within 60 calendar days. To ensure a timely and appropriate resolution of the appeal, HealthKeepers, Inc. recommends providers:

• Include the word appeal in bold in the request.

• Include, if available, the patient’s name, identification number, date(s) of service, claim number(s) and case number with HealthKeepers, Inc.

• Include the specific reason(s) for the appeal; giving a generic reason for the appeal will make it difficult to respond timely and appropriately.

• Include all relevant information, such as medical records or other supporting documentation, regardless of whether it was considered at the time the initial decision was made.

If the claim appeal is denied or a provider receives reduced reimbursement through the appeal process, their appeal rights have been exhausted. The final denial letter will state that the provider has exhausted appeal rights with HealthKeepers, Inc., and that the next level of appeal is with the Department of Medical Assistance Services (DMAS). It will also include the standard DMAS appeal rights, including the time period and address to file the appeal. The appeal to DMAS is considered the third-level appeal.

Before appealing to DMAS, providers must first exhaust all appeal processes with HealthKeepers, Inc. All DMAS provider appeals must be submitted in writing within 30 days of the first-level resolution letter from HealthKeepers, Inc. The second-level state appeal must be submitted to:

DMAS Appeals Division

600 E. Broad St.

Richmond, VA 23219

Note: DMAS normal business hours are 8 a.m. to 5 p.m. ET; DMAS will consider the appeal untimely if it is submitted on the deadline day after 5 p.m.

As we prepare for the potential regulatory-proposed standards for electronic attachments, HealthKeepers, Inc. will be implementing X12 275 electronic attachment transactions (version 5010) for claims for Anthem HealthKeepers Plus members.

Standard electronic attachments will bring value to you by eliminating the need for mailing paper records and reducing processing time overall. 

HealthKeepers, Inc. and Availity will pilot electronic data interchange batch electronic attachments with previously selected providers. Both solicited and unsolicited attachments will be included in our pilots.

Attachment types

• Solicited attachments: The provider sends a claim and the payer determines there is not enough information to process the claim. The payer will then send the provider a request for additional information (currently done via letter). The provider can then send the solicited attachment transaction, with the documentation requested, to process the claim.

• Unsolicited attachment: When the provider knows that the payer requires additional information to process the claim, the provider will then send the X12 837 claim with the Paper Work Included segment tracking number. Then, the provider will send the X12 275 attachment transaction with the additional information and include the tracking number that was sent on the claim for matching.

What you can do

As we prepare for this change, you can help now by having conversations with your clearinghouse and/or electronic healthcare records vendor to determine their ability to set up the X12 275 attachment transaction capabilities.

In addition, you should be on the lookout for additional information and details about working with HealthKeepers, Inc. and Availity to send attachments via electronic batch.

Currently, HealthKeepers, Inc. requires providers to submit various Anthem HealthKeepers Plus pre-service requests to AIM Specialty Health® (AIM). As part of our ongoing quality improvement efforts for outpatient diagnostic imaging services, cardiac procedures and sleep studies, AIM may request documentation to support the clinical appropriateness of certain requests.

When requested, providers should verify information by submitting documentation from the medical record and/or participating in a pre-service consultation with an AIM physician reviewer. If medical necessity is not supported, the request may be denied as not medically necessary.