NOTE TO STAFF: It is imperative that your office updates any changes to your practice via the Provider Maintenance Form on anthem.com.

The impact of COVID-19 in 2020 prohibited Anthem from conducting the annual after-hours access studies to assess phone messaging for our members for perceived emergency or urgent situations after regular office hours.  We will resume the survey in the second quarter of 2021 and expect when your office is contacted, you will be able to accommodate a member’s urgent concerns after hours.

To be compliant, per the Provider Manual, have your messaging or answering service include appropriate instructions, such as:

Emergency situations

The compliant response for an emergency instructs the caller/patient to hang up and call 911 or go to ER or connects the caller directly to the doctor.  

Urgent situations

The compliant response for urgent needs would direct the caller to Urgent Care or ER, to call 911 or connect the caller to their doctor or the doctor on call. 

Messaging that only gives callers the option of contacting their health care practitioner (via transfer, cell phone, pager, text, email, voicemail, etc.) or to get a call back for urgent questions or instructions is NOT complaint, as there is no direct connection to their health care practitioner. This prompt can be used in addition to, but not in place of the emergency and urgent instructions. 

Is your practice compliant?

Virginia’s Balance Billing legislation (SB172/HB1251) goes into effect January 1, 2021.  (Balance billing often occurs when a member receives care from an out-of-network provider at a network-participating facility.) This new legislation protects eligible members from balance billing when certain services are rendered by an out-of-network provider.  

As a requirement of this legislation, Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. will begin displaying hospital-based providers in our provider directories.  Historically, information regarding these types of providers has been suppressed from the provider directories, as members do not typically schedule direct appointments for services of these providers.  This change allows our members to verify our in-network, hospital-based providers (such as Radiologists, Pathologists, Emergency Medicine providers, Anesthesiologists, and others).  This change will occur in mid- to late November.  For more information about this new legislation, please refer to the State Corporation Commissions website at the following link: https://www.scc.virginia.gov/pages/Balance-Billing-(1).

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New health plans built around Anthem’s Blue High Performance Network (HPN) take effect January 1, 2021

Blue HPN® plans offer access to a select set of providers with a record of delivering high-quality, efficient care. Blue HPN networks will go live January 1, 2021, in more than 50 cities across the country.  In Virginia, Blue HPN networks will be in place in the Richmond and Washington, D.C-Arlington-Alexandria metro areas. Anthem is offering Virginia national employers Blue HPN plans, and offering large and small group employers in Virginia plans with access to the HPN, referred to as the Blue Connection network.

The Virginia Blue Connection network is a closed narrow network by design, and network participation is offered by invitation only.  If you are a participating professional provider, please note that only those provider offices that are physically located within the designated metro areas (as determined by zip code) will be considered in network.   Facility and Ancillary providers (such as Physical Therapy, Occupational Therapy, Speech Therapy, Ambulance, Audiology, etc.) have different participation requirements.

A special note for our professional providers located in the northern Virginia Anthem/CareFirst service area:  Participation in the Anthem Blue Connection network is based on the physical office location’s nine- digit zip code.

If you are not sure whether your practice is part of the Blue HPN/Blue Connection network, ask your office manager or business office, or contact your Anthem network representative. Blue HPN participation will be displayed in provider profiles in our provider directory January 1, 2021.

Beginning January 1, you may see patients accessing this network through either a national employer plan, Blue HPN, or large or small group employer EPO plans and HSA plans with EPO network. Under EPO plans, out-of-network benefits are limited to emergency or urgent care. Members may be required to select a primary care provider (PCP), but PCP referrals are not required for specialty care.

Large group Blue HPN health plans sold in Virginia will have a plan prefix of H8V and small group plans prefixes will include H9V and H5V.  Keep in mind that other prefixes may be part of HPN plan member IDs. The new “Blue High Performance Network” logo and “HPN” indicator in the suitcase icon are the most reliable indicators that a member is enrolled in a HPN plan.


The above SAMPLE Virginia ID card is for illustration purposes only.

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Through predictive analytics, health care teams can now receive real-time solutions to claim denials

Anthem is committed to providing digital first solutions. Our health care teams can now use self-service tools to reduce the amount of time spent following up on claim denials. Through the application of predictive analytics, Anthem has the answers before you ask the questions. With an initial focus on claim-level insights, Anthem has streamlined claim denial inquiries by making the reasons for the claim denial digitally available. In addition to the reason for the denial, we supply you with the next steps needed to move the claim to completion. This eliminates the need to call for updates and experience any unnecessary delays waiting for the explanation of benefits (EOB).

Access Claims Status Listing on Payer Space from our secure provider portal through anthem.com using the Log In button, or through the Availity Portal. We provide a complete list of claims, highlight those claims that have proactive insights, provide a reason for the denial, and the information needed to move the claim forward.

Claim resolution daily

Automated updates make it possible to refresh claims history daily. As you resolve claim denials, the claim status changes, other claims needing resolution are added, and claims are resolved faster.

Anthem has made it easier to update and supply additional information, too. While logged into the secure provider portal, you have the ability to revise your claim, add attachments, or eliminate it if filed in error. Even if you did not file the claim digitally, you can access the proactive insights. Predictive analytics supplies the needed claim denial information online – all in one place.

Predictive proactive issue resolution and near real-time digital claim denial information is another example of how Anthem is using digital technology to improve the health care experience.

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The Provider Digital Engagement Supplement is another example of how Anthem Blue Cross and Blue Shield (Anthem) is using digital technology to improve the health care experience. The Supplement outlines Anthem provider expectations, processes and self-service tools across all electronic channels, including medical, dental, and vision benefits all in one comprehensive resource. We want providers to go digital with Anthem no later than January 1, 2021, so we can realize our mutual goals of reducing administrative burden and increasing provider satisfaction and collaboration.

Reduce the amount of time spent on transactional tasks by more than 50% when using our secure provider portal or EDI submissions (via Availity) to:

• File claims

• Check statuses

• Verify eligibility and benefits

• Submit prior authorizations

Through self-service functions, you can accomplish digital transactions all at one time, all in one place. If you are not already registered, visit anthem.com and use the Log In button for access to our secure provider portal or via the Availity EDI Portal.

Get payments faster

• Electronic Funds Transfer (EFT) eliminate the need for paper checks. Payments are deposited directly to your bank account. It is safe, secure and you receive payments faster.

Eliminate paper remittances

• Electronic remittance advice (ERA) is completely searchable and downloadable from the secure provider portal or the EDI 835 remittance. Meeting all mandates of the Health Insurance Portability and Accountability Act (HIPAA), ERAs eliminate the need for paper remittances.

Member IDs go digital

Having an ID card emailed directly to you from the member for file upload eliminates the need for you to scan or print, making it easier for you and the member. Health care teams can also directly access the digital member ID card from the secure provider portal through Availity. Save time by accepting the digital member ID cards when presented by the member via their App or email.

Read more about going digital with Anthem in the Provider Digital Engagement Supplement available online.  Go to anthem.com > Providers > Forms and Guides > Digital Tools.

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As of December 1, 2020, the providers listed in the attachment under the "Article Attachments" section to the right are participating air ambulance providers with Anthem Blue Cross and Blue Shield in Virginia.  That means, for members picked up in Virginia, these participating providers have contractually agreed to accept the Anthem Rate as payment in full for approved and medically necessary transport, and they will bill those members for cost-shares only.

Some air ambulance providers choose not to participate with Anthem. 

• These air ambulance providers may, and often do, charge members rates that are significantly higher than the Anthem contracted provider rates.

• These non-contracted air ambulance providers attempt to collect from Anthem members the difference between Anthem’s allowed amount and the provider’s billed amount.

To help Anthem members avoid the high costs of air transportation from non-contracted providers, we ask that, whenever possible, you choose a participating air ambulance provider for your patients who are Anthem members.  Utilizing participating providers:  

• Protects the member from balance billing for what may be excessive amounts,

• Assures the most economical use of the member’s benefits, and

• Is consistent with your contractual obligations to refer to in-network providers where available.

To schedule fixed wing or rotary wing air ambulance services, please

1. Contact Anthem for precertification for all non-emergent transports, using the number on the back of the member’s ID card, then
2. Call one of the phone numbers listed in the attachment.  (Select the link under "Article Attachments" to the right.)

Please have the following information ready when you call one of the contracted air ambulance providers:

• Basic medical information about the patient, including the patient’s name and date of birth or age.  If the service was not precertified with Anthem, the air ambulance provider will also need to receive a full medical report from the attending facility.

• Current location of the patient, the name of the hospital or facility caring for the patient and its address (city and state).

• Location where patient is to be transported, including the name of the destination hospital/facility and address.

• Approximate transport date or timeframe.

• Special equipment or care needs.

Should you have questions regarding the air ambulance network, including providers contracted for air ambulance pickups outside of Virginia, please contact your Anthem Provider Network Manager.

For a list of contracted air ambulance providers for Anthem in Virginia, select the link under the "Article Attachments" section above. 

To arrange air transport originating outside the United States, U.S. Virgin Islands, and Puerto Rico:

Call 800-810-BLUE or BCBS Global Core formerly BlueCard Worldwide.

Are you looking for creative ways to talk to your patients about certain preventive care services such as breast cancer screening and adolescent vaccinations including the HPV vaccination?  As flu season approaches, do you want a way to educate your patients about the dangers of antibiotic resistance?  Short educational videos, approximately two minutes in length, are available on anthem.com > Providers > Forms and Guides > under the Category heading, select Patient Care. 

By providing education and addressing common fears and concerns, these brief videos offer an alternative approach to patient engagement on these important topics.  Take a look today.

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An updated BlueCard® Program Provider Manual will be available on anthem.com – our public provider website – on January 1, 2021.  The manual includes enhanced content and should be helpful in understanding the BlueCard® (out of area) Program that enables members of one Blue Plan to obtain health care service benefits while traveling or living in another Blue Plan’s service area. 

To locate the manual, go to www.anthem.com, select Providers and then Provider Overview and your state.  From the horizontal menu, select “Policies, Guidelines and Manuals” under Provider Resources.  Scroll down to the Provider Manual section and select “Download the Manual.”  On the Provider Manual page, scroll down to the Provider Manual Library and select the BlueCard Provider Manual.

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Managing illness can sometimes be a difficult thing to do. Knowing who to contact, what test results mean or how to get needed resources can be a bigger piece of a healthcare puzzle that for some, are frightening and complex issues to handle.

Anthem is available to offer assistance in these difficult moments with our Case Management Program.  Our case managers are part of an interdisciplinary team of clinicians and other resource professionals that are there to support members, families, primary care physicians and caregivers.  The case management process utilizes experience and expertise of the care coordination team whose goal is to educate and empower our members to increase self-management skills, understand their illness, and learn about care choices in order to access quality, efficient health care.

Members or caregivers can refer themselves or family members by calling the number located in the grid below.  They will be transferred to a team member based on the immediate need.  Physicians can also refer by contacting us telephonically or through electronic means.  No issue is too big or too small.  We can help with transitions across level of care so that patients and caregivers are better prepared and informed about healthcare decisions and goals.

How do you contact us?

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Coordination of care among providers is a vital aspect of good treatment planning to ensure appropriate diagnosis, treatment and referral.  Anthem Blue Cross and Blue Shield (Anthem) would like to take this opportunity to stress the importance of communicating with your patients’ other health care practitioners. This includes primary care physicians (PCPs) and medical specialists, as well as behavioral health practitioners.

Coordination of care is especially important for patients with high utilization of general medical services and those referred to a behavioral health specialist by another health care practitioner.  Anthem urges all of our practitioners to obtain the appropriate permission from these patients to coordinate care between Behavioral Health and other health care practitioners at the time treatment begins.

We expect all health care practitioners to:

1. Discuss with the patient the importance of communicating with other treating practitioners.

2. Obtain a signed release from the patient and file a copy in the medical record.

3. Document in the medical record if the patient refuses to sign a release.

4. Document in the medical record if you request a consultation.

5. If you make a referral, transmit necessary information; and if you are furnishing a referral, report appropriate information back to the referring practitioner.

6. Document evidence of clinical feedback (such as a consultation report) that includes, but is not limited to:

• Diagnosis

• Treatment plan

• Referrals

• Psychopharmacological medication (as applicable)

In an effort to facilitate coordination of care, Anthem has several tools available on the provider website including a Coordination of Care Form and Coordination of Care Letter Templates for both Behavioral Health and other Medical Practitioners.* Behavioral Health tools are available, which includes forms, brochures, and screening tools for Substance Abuse, Attention-deficit/hyperactivity disorder (ADHD), and Autism. Please refer to the website for a complete list.**

*Access to the forms and template letters are available at www.anthem.com/provider/forms/

**Access to the Behavioral Health tools are www.anthem.com/provider/forms/

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Our utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as the member’s coverage according to their health plan. We do not reward providers or other individuals for issuing denials of coverage, service or care. Nor, do we make decisions about hiring, promoting, or terminating these individuals based on the idea or thought that they will deny benefits.  In addition, we do not offer financial incentives for UM decision makers to encourage decisions resulting in under-utilization.  Anthem’s coverage guidelines are available on Anthem’s website at anthem.com.

You can also request a free copy of our UM criteria from our medical management department, and providers may discuss a UM denial decision with a physician reviewer by calling us at the toll-free numbers listed below.  UM criteria are also available on the Web.  Just go to anthem.com, then scroll down and select Tools for Providers > Find Information That’s Tailored for You? > Select State > Review Policies? > View Coverage and Clinical UM Guidelines.

We work with providers to answer questions about the utilization management process and the authorization of care.  Here’s how the process works:

• Call us toll free from 8:30 a.m. - 5 p.m. Monday through Friday (except on holidays). More hours may be available in your area.  Federal Employee Program hours are 8 a.m. – 7 p.m. Eastern.

• If you call after normal business hours, you can leave a private message with your contact information. Our staff will return your call on the next business day.  Calls received after midnight will be returned the same business day. 

• Our associates will contact you about your UM inquiries during business hours, unless otherwise agreed upon.

 
*Business hours: 

Call us toll free from 8:30 a.m. - 5 p.m. ET, Monday through Friday (except on holidays).  More hours may be available in your area.  Federal Employee Program hours are 8 a.m. – 7 p.m. ET.

For language assistance, members can simply call the Customer Service phone number on the back of their ID card and a representative will be able to assist them.

Our utilization management associates identify themselves to all callers by first name, title and our company name when making or returning calls.  They can inform you about specific utilization management requirements, operational review procedures, and discuss utilization management decisions with you.

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The delivery of quality health care requires cooperation between patients, their providers and their health care benefit plans. One of the first steps is for patients and providers to understand their rights and responsibilities. Therefore, in line with our commitment to involve the health plan, participating practitioners and members in our system, Anthem Blue Cross and Blue Shield has adopted a Members’ Rights and Responsibilities statement.

It can be found on our website, under the FAQ question about “Laws and Rights that Protect You.”  To access, go to anthem.com and select “Provider.”  From there, select “Policies, Guidelines & Manuals” under Provider Resources.  Select your state, and scroll down to “Member Rights and Responsibilities” under More Resources.  Click the “Read about member rights” link.  Practitioners may access the Federal Employee Program (FEP) member portal at www.fepblue.org/memberrights  to view the FEPDO Member Rights Statement.

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NOTE TO STAFF: It is imperative that your office updates any changes to your practice via the Provider Maintenance Form on anthem.com.

The impact of COVID-19 in 2020 prohibited Anthem from conducting the annual appointment access studies to assess how well practices meet appointment access requirements for our members for behavioral health care (BH). We will resume the survey in second quarter 2021 and expect when your office is contacted, you will be able to accommodate a member’s needs in a timely manner.

To be compliant, per the Provider Manual, providers should meet the following access standards:

Methods used to monitor adherence to these standards consist of assessing the accessibility of appointments via phone calls from North American Testing Organization, a vendor working on Anthem’s behalf, and analysis of member complaint and member experience data.

Effective December 8, 2020, HealthKeepers, Inc. will transition the clinical criteria for Anthem HealthKeepers Plus medical necessity review of certain outpatient rehabilitative services from our clinical guidelines for physical therapy CG-REHAB-04, occupational therapy CG-REHAB-05 and speech language pathology CG-REHAB-06 to AIM Specialty Health_®* Rehabilitative Service Clinical Appropriateness Guidelines. These reviews will continue to be completed by the VA utilization management team.

Access and download a copy of the current and upcoming guidelines.

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.

* AIM Specialty Health is an independent company providing some utilization review services on behalf of HealthKeepers, Inc.

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Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

Consumer Assessment of Healthcare Providers and Systems (CAHPS)^® is an annual standardized survey conducted to assess consumer experience with their health care services and health plan. Providers and their staff play a key role in the member experience. Several questions specific to the member’s experience with their provider are included in the CAHPS survey. Education about the CAHPS survey, the importance of focusing on the patient experience and ways to improve the patient experience are included in the Provider Orientation and available by visiting https://mediproviders.anthem.com/va.

CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).

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Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

We are now using the Notification Center on the Availity* Portal home page to communicate vital and time sensitive information. You will see a Take Action call out and a red flag in front of the message to make it easy to see new items requiring your attention.

Viewing the Notification Center updates should be included as part of your regular workflow so that you are aware of any outstanding action items.

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.

* Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc.

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Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

Across the nation, too many women continue to experience pregnancy-related complications and death. More than 700 women die each year in the United States as a result of complications related to pregnancy or delivery.¹ Many of these deaths are preventable. In addition, significant racial and ethnic disparities exist in maternal morbidity and mortality. For example, Black/African American and American Indian/Alaska Native women are two to three times more likely to die from pregnancy-related complications compared to White women.² HealthKeepers, Inc. recognizes your role at the front lines of defense to support your diverse pregnant and postpartum patients. We want to ensure you have the right tools and resources to help your patients understand their risks and key maternal warning signs.

The Centers for Disease Control and Prevention (CDC) recently launched the Hear Her campaign to raise awareness of pregnancy-related complications, risks and death. The Hear Her campaign aims to increase knowledge of the symptoms women should seek medical attention for during pregnancy and in the year after delivery, such as vision changes and chest pain. Resources are available for pregnant and postpartum women, partners, families and friends, and health care providers.

The Hear Her campaign reminds us of the importance of listening to women. As a health care provider, you have an opportunity to listen to pregnant women, engage in an open conversation to make certain their concerns are adequately addressed, and help your patients understand urgent maternal warning signs. You can find more information on the CDC's Hear Her campaign at www.cdc.gov/hearher.

In addition, the Council on Patient Safety in Women's Health Care developed a tool to help women identify urgent maternal warning signs. The Urgent Maternal Warning Signs tool helps women recognize the symptoms they may experience during and after pregnancy that could indicate a life-threatening condition. The tool also provides additional information on the symptoms and conditions that place women at increased risk for pregnancy-related death. You can find the Council on Patient Safety in Women's Health Care Urgent Maternal Warning Signs tool at www.safehealthcareforeverywoman.org/urgentmaternalwarningsigns.

If you have a pregnant member in your care who would benefit from case management, please call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687. Members can also call our 24/7 NurseLine at the number on their member ID card.

References

¹   Centers for Disease Control and Prevention. (2020, August 13). Reproductive Health: Maternal Mortality. Retrieved from https://www.cdc.gov/reproductivehealth/maternal-mortality/index.html.

²  Centers for Disease Control and Prevention. (2019, September 5). Racial and Ethnic Disparities Continue in Pregnancy-Related Deaths. Retrieved from https://www.cdc.gov/media/releases/2019/p0905-racial-ethnic-disparities-pregnancy-deaths.html.

Please note, this communication applies to Anthem HealthKeepers Plus and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.

HealthKeepers, Inc. appreciates the recent improvements seen in early elective delivery (EED) rates across the country. These improvements have been brought about through the collaborative efforts of state Medicaid agencies, the March of Dimes, CMS, the Joint Commission, the American College of Obstetricians and Gynecologists (ACOG), and many others. The implementation of hospital hard stop policies describing the review of clinical indications and scheduling approval for EED has also increased awareness of the harm that can be caused by non-medically necessary EED and encouraged discussion on the topic between patients, their care providers and hospitals. Voluntary efforts combined with payment reform have been found to further decrease EED rates while increasing gestational age and birth weight for the covered population.¹

Early elective delivery is defined as a delivery by induction of labor without medical necessity followed by vaginal or caesarean section delivery or a delivery by caesarean section before 39 weeks gestation without medical necessity. Vaginal or caesarean delivery following non-induced labor is not considered an early elective delivery regardless of gestational weeks.

What does this mean for providers?

To improve birth outcomes for our members and further reduce EED, HealthKeepers, Inc. requires a Z3A code indicating gestational age, the appropriate code to indicate the outcome of delivery and supporting medical necessity diagnosis codes on all professional delivery claims for all EED. HealthKeepers, Inc. will apply Milliman Care Guidelines, which defines medically necessary criteria for EED.

All professional delivery claims (59400, 59409, 59410, 59510, 59514, 59515, 59525, 59610, 59612, 59614, 59618, 59620, 59622) with dates of service December 1, 2019, or after, will require a Z3A code indicating gestational age at the time of delivery. If the code is not present on the claim, the claim will deny with the explanation code e02: Delivery diagnoses incomplete without report of pregnancy weeks of gestation. You may resubmit the claim with the appropriate Z3A code.

• Professional delivery claims with dates of service December 1, 2019, or after, with gestational age dates of 37 and 38 weeks will require a supporting medically necessary diagnosis code for the early delivery.

• If a professional delivery claim is submitted without evidence of medical necessity for the early delivery, the claim will deny with code k34: Delivery is not medically indicated. You may resubmit the claim with the appropriate supporting diagnosis code or appeal with medical records.

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. Thank you for being a valued partner. We appreciate your commitment to the health of our members.

¹ Dahlen, Heather M., J. Mac Mccullough, Angela R. Fertig, Bryan E. Dowd, and William J. Riley. Texas Medicaid Payment Reform: Fewer Early Elective Deliveries and Increased Gestational Age and Birthweight. Health Affairs 36.3 (2017): 460-67. Print.

Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

You may be surprised to learn that suicide is currently the 10th leading cause of death in the United States. In 2017 alone, there were an estimated 1.4 million suicide attempts by Americans. As staggering as these numbers are, we’d like to focus on what can be done to mitigate these statistics. The front lines in the battle against suicide are prevention and intervention. According to the CDC, suicide prevention should incorporate reducing factors that increase risk and increasing factors that help with resilience and/or coping.

Please read through the information below, which can be used to both prevent and intervene when it comes to suicide and your Anthem HealthKeepers Plus patients.

While the following statistics may be hard to read, awareness plays a big role in solving this issue:

• Nearly 45,000 lives were lost to suicide in 2016.

• Suicide rates went up more than 30% in half of U.S. states since 1999.

• There was a significant rise in suicide rate among youth ages 10 to 14.

• Suicide is the second leading cause of death for people 10 to 34 years of age.

• Men are more likely to use more lethal methods, such as firearms or suffocation, while women are more likely to attempt suicide by poisoning or prescription overdose.

• American Indian/Alaska Native youth and middle-aged persons have the highest rate of suicide.

Understanding who is at risk is vital to suicide prevention/intervention. The following traits are risk indicators:

• Depression, other mental disorders or substance use disorder
• Chronic pain
• A prior suicide attempt
• Family history of a mental disorder, substance use or suicide
• Family violence, including physical or sexual abuse
• Having guns or other firearms in the home
• Having recently been released from prison or jail
• Being exposed to others' suicidal behavior, such as that of family members, peers or celebrities

• Talking about wanting to die or to kill oneself
• Looking for a way to kill oneself, such as searching online or buying a gun
• Talking about feeling hopeless or having no reason to live
• Talking about feeling trapped or in unbearable pain
• Talking about being a burden to others
• Increasing the use of alcohol or drugs
• Acting anxious or agitated; behaving recklessly
• Sleeping too little or too much
• Withdrawing or feeling isolated
• Showing rage or talking about seeking revenge
• Displaying extreme mood swings

• Ask the question, “Are you thinking of killing yourself?”
• Keep them safe from harming or endangering themselves.
• Be there and promote a connectedness.
• Help them connect to to resources.
• Follow up with your patient after determining they are at risk.

• Health care providers can help prevent suicide when they understand the risk factors and use evidence‑based treatments and therapies.

• The Joint Commission recommends screening all patients in all medical settings for suicide risk using validated, population- and setting-specific tools.

• It is no longer acceptable to contract for safety with patients; you need to remove or ensure safe storage of potentially lethal items.

• Familiarize yourself with the social media outlets in order to identify suicidal content and get help for the person posting the message. Websites such as Instagram, Facebook, Snapchat, Tumblr, Twitter and YouTube have built-in safety tools.

• National Suicide Prevention Lifeline: 1-800-273-TALK (8255) — This is a free, 24-hour hotline available to anyone in suicidal crisis or emotional distress. Callers are routed to the closest crisis center within Lifeline’s network of more than 160 centers.

• Suicide Prevention Resource Center (SPRC) — SPRC provides technical assistance, training and materials to assist states, tribes, campuses, organizations, professionals and stakeholders develop suicide prevention programs, interventions and policies. SPRC also acts as Secretariat to the National Action Alliance for Suicide Prevention.

• National Action Alliance for Suicide Prevention — This is a public/private partnership that advances the National Strategy for Suicide Prevention through the work of nearly 200 organizations.

• Behavioral Health Treatment Services Locator — This tool is a directory of mental health and substance use treatment facilities in the United States and United States territories.

• Garrett Lee Smith Suicide Prevention Program — The purpose of this program is to support states and tribes with implementing youth suicide prevention and early intervention strategies in schools, educational institutions, juvenile justice systems, substance use programs, mental health programs, foster care systems, and other child- and youth-serving organizations.

• Tribal Technical Assistance Center (TTAC) — The TTAC provides culturally relevant, evidence-based, holistic technical assistance to support native communities who seek to address mental and substance use disorders and suicide.

• National Action Alliance for Suicide Prevention: actionallianceforsuicideprevention.org

• National Indian Child Welfare Association: http://www.icctc.org/August2013/PMM%20Handouts/Youth%20Suicide%20Prevention%20Toolkit.pdf

• Indian Health Services Resources:  ihs.gov/behavioral/index.cfm?module=BH&option=Suicide

• Veterans Crisis Line: veteranscrisisline.net

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.

References

1. American Foundation for Suicide Prevention (2019). Suicide Statistics. Retrieved from:

https://afsp.org/about-suicide/suicide-statistics.

2. Centers for Disease Control and Prevention (2018). Suicide: Prevention strategies. Retrieved from https://www.cdc.gov/violenceprevention/suicide/prevention.html.
3. National Institute of Mental Health (2017, May). Mental health information. NIH. Retrieved from

https://www.nimh.nih.gov/health/index.shtml.

4. Substance Abuse and Mental Health Services Administration (n.d). SAMHSA. Retrieved from samhsa.gov.
5. Suicide Prevention Lifeline. National Suicide Prevention Lifeline. Retrieved from https://suicidepreventionlifeline.org.

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Please note, this communication applies to Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc. Thank you for being an Anthem HealthKeepers Plus provider and supporting our members.

We’re the brand Virginians have trusted for more than 20 years

Anthem CCC Plus member open enrollment is October 1, 2020, to December 18, 2020.

Your Medicaid patients receive all the Anthem CCC Plus benefits, plus extras at no cost for eligible Anthem HealthKeepers Plus members.

Anthem HealthKeepers Plus members also receive:

• Dental cleaning, exam and X-rays twice a year.

• $100 for eyeglasses, including lenses and frames.

• Hearing exam and up to $1,000 for hearing aids, including 60 batteries and unlimited fittings.

• Meal delivery to their home after a hospital stay.

• Coupon books with over $1,000 in savings.

• 12 rides to grocery stores, hair salons, local events and more.

• $50 for assistive devices and $50 for walker and wheelchair accessories.

Provide this information to your patients so they can choose the state’s largest Medicaid plan now

For more information, your patients can visit www.cccplusva.com or call 1-844-374-9159 (TTY 711) and tell them they want the Anthem HealthKeepers Plus plan. Visit www.anthem.com/vamedicaid.

Please note, this invitation applies to Anthem HealthKeepers Plus and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc.

HealthKeepers, Inc. invites you and your staff to a webinar covering important information for:

• Anthem HealthKeepers Plus providers.

• Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus
  (Anthem CCC Plus) providers.

Online sessions will include information about provider responsibilities, precertification and preauthorization, claims submission, appeals and denials, and common billing errors.

The session dates are listed below. Please follow the link, select the session date of the orientation that you would like to attend from the drop-down list and register.

Link: https://tinyurl.com/Anthem-Medicaid

* All webinars are listed in Eastern time.

If you have questions regarding upcoming provider orientations, please contact Jamal Matthews in Provider Services at Jamal.Matthews@anthem.com.

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Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.

Introducing the HealthKeepers, Inc. Provider Digital Engagement Supplement to the provider manual

Using our secure provider portal or Electronic Data Interchange (EDI) submissions (via Availity*), administrative tasks can be reduced by more than 50% when filing claims with or without attachments, checking statuses, verifying eligibility, benefits and when submitting prior authorizations electronically. In addition, it could not be easier. Through self-service functions, you can accomplish digital transactions all at one time, all in one place. If you are not already registered, just go to EDI or the secure provider portal (Availity).

Get payments faster

By eliminating paper checks, electronic funds transfer (EFT) is a digital payment solution that deposits payments directly into your account. It is safe, secure and will deliver payments to you faster. Electronic remittance advice (ERA) is completely searchable and downloadable from the Availity Provider Portal or the EDI 835 remittance, which meets all mandates of the Health Insurance Portability and Accountability Act (HIPAA) — eliminating the need for paper remittances.

Member ID cards go digital

Members who are transitioning to digital member ID cards, will find it is easier for them and you. The ID card is easily emailed directly to you for file upload, eliminating the need to scan or print. In addition, the new digital member ID card can be directly accessed through the secure provider portal via Availity. Providers should begin accepting the digital member ID cards when presented by the member.

HealthKeepers, Inc. makes going digital easy with the Provider Digital Engagement Supplement

From our digital member ID cards, EDI transactions, application programming interfaces and direct data entry, we cover everything you need to know in the Provider Digital Engagement Supplement to the provider manual, available by going to https://mediproviders.anthem.com/va/pages/manuals-directories-training.aspx > Manuals, Directories, Training & Resources > Anthem HealthKeepers Plus Manuals, Directories, Training & Resources > Provider Digital Engagement, and on the secure Availity Provider Portal. The supplement outlines our provider expectations, processes and self-service tools across all electronic channels Medicaid, including medical, dental and vision benefits.

The Provider Digital Engagement Supplement to the provider manual is another example of how HealthKeepers, Inc. is using digital technology to improve the health care experience. We are asking providers to go digital with HealthKeepers, Inc. no later than January 1, 2021, so we can realize our mutual goals of reducing administrative burden and increasing provider satisfaction and collaboration. Read the Digital Engagement Supplement now by going to https://mediproviders.anthem.com/va/pages/manuals-directories-training.aspx > Manuals, Directories, Training & Resources > Anthem HealthKeepers Plus Manuals, Directories, Training & Resources > Provider Digital Engagement, and go digital with HealthKeepers, Inc.

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.

* Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc.

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 the topics we’re addressing in this edition:

Policy Reminder — Nurse Practitioner and Physician Assistant Services, Professional

 AVA-NU-0283-20

Transition to AIM small joint guidelines

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Anti-VEGF Medical Step Therapy Notice

Introducing the Anthem Blue Cross and Blue Shield (Anthem) Provider Digital Engagement Supplement to the provider manual

Using our secure provider portal or Electronic Data Interchange (EDI) submissions (via Availity*), administrative tasks can be reduced by more than 50% when filing claims with or without attachments, checking statuses, verifying eligibility, benefits and when submitting prior authorizations electronically. In addition, it could not be easier. Through self-service functions, you can accomplish digital transactions all at one time, all in one place. If you are not already registered, just go here for EDI or here for the secure provider portal (Availity).

Get payments faster

By eliminating paper checks, electronic funds transfer (EFT) is a digital payment solution that deposits payments directly into your account. It is safe, secure and will deliver payments to you faster. Electronic remittance advice (ERA) is completely searchable and downloadable from the Availity Provider Portal or the EDI 835 remittance, which meets all mandates of the Health Insurance Portability and Accountability Act (HIPAA) — eliminating the need for paper remittances.

Member ID cards go digital

Members who are transitioning to digital member ID cards, will find it is easier for them and you. The ID card is easily emailed directly to you for file upload, eliminating the need to scan or print. In addition, the new digital member ID card can be directly accessed through the secure provider portal via Availity. Providers should begin accepting the digital member ID cards when presented by the member.

Anthem makes going digital easy with the Provider Digital Engagement Supplement

From our digital member ID cards, EDI transactions, application programming interfaces and direct data entry, we cover everything you need to know in the Provider Digital Engagement Supplement to the provider manual, available at https://www.anthem.com/medicareprovider > select your state > Providers > Policies, Guidelines & Manuals, and on the secure Availity Provider Portal. The supplement outlines our provider expectations, processes and self-service tools across all electronic channels Medicaid and Medicare, including medical, dental and vision benefits.

The Provider Digital Engagement Supplement to the provider manual is another example of how Anthem is using digital technology to improve the health care experience. We are asking providers to go digital with Anthem no later than January 1, 2021, so we can realize our mutual goals of reducing administrative burden and increasing provider satisfaction and collaboration. Read the Provider Digital Engagement Supplement now by going to https://www.anthem.com/medicareprovider > select your state > Providers > Policies, Guidelines & Manuals. Go digital with Anthem.

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

Summary of benefits, evidence of coverage and formularies for 2021 individual Medicare Advantage plans will be available at anthem.com/medicareprovider. An overview of notable 2021 benefit changes will be available at anthem.com/medicareprovider> Read News and Updates. Please continue to check anthem.com/medicareprovider for the latest Medicare Advantage information.

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How do I check eligibility and benefits for these members?

Online — Eligibility, benefits, claims, links to secure messaging, commonly used forms and remit information are all available through the Availity* Portal at https://www.availity.com. For questions on access and registration, call Availity Client Services at 1-800-AVAILITY (1-800-282-4548). Availity Client Services is available Monday through Friday, 8 a.m. to 7 p.m. ET (excluding holidays) to answer your registration questions.

Phone — Call the Provider Service number on the back of the member’s ID card. You may also verify a member’s eligibility by calling the BlueCard Eligibility Line at 1‑800‑676‑BLUE (2583) and providing the member’s three-digit alpha prefix located on the ID card.

As new members enroll in Group Retiree Medicare Advantage plans under Anthem Blue Cross and Blue Shield, they will receive new ID cards. Additionally, existing members may receive new ID cards as a result of benefit changes. Please continue to check member ID cards to ensure you have the most up-to-date eligibility and benefit information.

Please note that we are experiencing an unusually high volume of changes for an effective date of January 1, 2021. Many of the changes do not affect member prefix, member ID or benefits, but some changes will. Because of this, we encourage providers to request a copy of the member’s ID card, particularly at the beginning of the year when members may have new ID cards.

What are the alpha prefixes for Group Retiree Medicare Advantage PPO members?

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

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The Medical Policies, Clinical Utilization Management (UM) Guidelines and Third-Party Criteria below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed.

Please share this notice with other members of your practice and office staff.

To view a guideline, visit https://www11.anthem.com/search.html.

Updates

Updates marked with an asterisk (*) notate that the criteria may be perceived as more restrictive.

• MED.00134 — Noninvasive Heart Failure and Arrhythmia Management and Monitoring System:
  • Revised Investigational and Not Medically Necessary indications
• SURG.00156 — Implanted Artificial Iris Devices:
  • Revised Investigational and Not Medically Necessary indications
• SURG.00157 — Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis:
  • Revised Investigational and Not Medically Necessary indications
• CG-DME-07 — Augmentative and Alternative Communication (AAC) Devices with Digitized or Synthesized Speech Output:
  • Revised Medically Necessary and Not Medically Necessary indications
• GENE.00052 — Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling:
  • Revised Medically Necessary indications
• SURG.00077 — Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques:
  • Expanded scope and revised Investigational and Not Medically Necessary indications
• SURG.00112 — Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures):
  • Revised scope, and Investigational and Not Medically Necessary indications
•  CG-REHAB-12 — Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology:

• The following AIM Specialty Health_®** Clinical Appropriateness Guidelines have been revised and will be effective on December 6, 2020. To view AIM guidelines, visit the AIM Specialty Health page:

Medical Policies

On August 13, 2020, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Anthem Blue Cross and Blue Shield (Anthem). These guidelines take effect December 6, 2020.

Clinical UM Guidelines

On August 13, 2020, the MPTAC approved the following Clinical UM Guidelines applicable to Anthem. These guidelines adopted by the medical operations committee for Medicare Advantage members on September 24, 2020. These guidelines take effect December 6, 2020.

** AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.

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Please continue to check Important Medicare Advantage Updates for the latest Medicare Advantage information, including:

Policy Update — Emergency Department: Leveling of Evaluation and Management Services.

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