Parents may not understand the importance of taking their children to the doctor when they are healthy. The benefits are documented by the American Academy of Pediatrics¹ as well as the Centers for Disease Control and Prevention,² and it all starts with a recommendation by you, the trusted physician. Share these benefits with parents during regularly scheduled well-visits, or even during sick visits, to reinforce the importance of staying on track:

 

• Prevention.  Regular wellness visits ensure children receive scheduled immunizations that prevent illness. It is also a great opportunity to discuss nutrition and safety in the home.

 

• Growth and development. Evaluating children for growth and development enables parents to see how much their children have grown since the last visit. It is also an opportunity to share the children’s development, to discuss milestones, social behaviors, and learning.

 

• Raising concerns. Offering parents an opportunity to share concerns at the start of the visit will help in your evaluation of the patient. They may want to talk about development, sleep and eating habits and behaviors.

 

• Team approach. Regular visits create strong, trustworthy relationships among physician, parent, and child. The American Academy of Pediatrics (AAP) supports well-child visits as a way for pediatricians and parents to serve the needs of children. This team approach helps develop optimal physical, mental, and social health of a child.

 

Measure up: Well-Child Visits in the first 30 months of life (W30)

 

This HEDIS® measure is described as the percentage of members who had to the following number of well-child visits with a PCP during the last 15 months. These rates are reported:

 

• Well-child visits in the first 15 months: Six or more well-child visits with children who turned age 15 months during the measurement year.

 

• Well-child visits for ages 15 to 30 months: Two or more well-child visits with children who turned age 30 months during the measurement year.

 

Tips

• Telehealth visits are acceptable in meeting the measurement requirements.
• Consider scheduling well-child visits in advance of the child reaching the age for the visit.

 

Coding

• ICD-10: Z00.110, Z00.111, Z00.121, Z00.129, Z00.2, Z00.3, Z02.5, Z76.1, Z76.2
• HCPCS: G0438-G0439, S0302
• CPT: 99381-99382, 99391-99392, 99461

 

¹Parent Plus: Importance of routine pediatrician visits. American Academy of Pediatrics. https://publications.aap.org/aapnews/news/12481?autologincheck=redirected

²Catch up on well-child visits and recommended vaccinations. Centers for Disease Control and Prevention. cdc.gov/vaccines/parents/visit/vaccination-during-COVID-19.html 

 

1509-0122-PN-VA

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

 

Effective January 1, 2022, CVS Specialty Pharmacy* and IngenioRx Specialty Pharmacy* will no longer distribute the brand name drug Botox,^® but it will still be available to Anthem HealthKeepers Plus members either through buy and bill or through an available retail pharmacy.

 

Please note:

 

• This is not a change in member benefits. This is a change in the Botox vendor only.

• If the member is not using CVS Specialty Pharmacy or IngenioRx Specialty Pharmacy to obtain Botox, no action is needed.

 

For Botox managed under a member’s medical benefit

 

Effective January 1, 2022, you will need to buy this drug and bill HealthKeepers, Inc.

 

If you have questions regarding a member’s medical specialty pharmacy benefits, call Anthem HealthKeepers Plus, Medallion Provider Services at 800‑901‑0020 or Anthem CCC Plus Provider Services at 855‑323‑4687.

 

For Botox managed under a member’s pharmacy benefit

 

Effective January 1, 2022, members who currently obtain Botox through IngenioRx Specialty Pharmacy using their pharmacy benefit must change to another in-network pharmacy that distributes Botox.

 

If you have questions regarding a member’s pharmacy benefit, call Anthem HealthKeepers Plus, Medallion Pharmacy Member Services at 833-207-3120 or Anthem CCC Plus Pharmacy Member Services at 833-235-2027.

* CVS is an independent company providing pharmacy services on behalf of HealthKeepers, Inc. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of HealthKeepers, Inc.

 

AVA-NU-0539-21

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

                                 

The HEDIS^® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality healthcare services. 

 

The ECDS Reporting Standard provides a method to collect, and report structured electronic clinical data for HEDIS quality measurement and improvement. 

 

Benefits to providers:

 

• Reduced burden of medical record review for quality reporting

• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

 

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

 

Learn more about NCQA’s digital quality system and what it means to you and your practice, at the following link: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

 

ECDS measures

 

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure.  In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

 

For HEDIS measurement year 2022, the following measures can be reported using ECDS: 

 

• Childhood Immunization Status (CIS-E)*
• Immunizations for Adolescents (IMA-E)*
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)*
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

 

* Indicates that this is the first year that the measure can be reported using ECDS.

 

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening and Follow-up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

 

If you have any questions about this communication, call Anthem HealthKeepers Plus, Medallion Provider Services at 800‑901‑0020 or Anthem CCC Plus Provider Services at 855‑323‑4687.

 

* HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

AVA-NU-0541-21

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

 

Consumer Assessment of Healthcare Providers and Systems (CAHPS^®) is an annual standardized survey conducted between January and May to assess consumer experiences with their provider and health plan, received by a random sample of patients. We use the results to measure our performance against our goals and determine the effectiveness of actions implemented to improve.

2021 NCQA Health Plan Star Rating

Survey Measures	2021 Rate	2021 All Affiliates Adult Medicaid Average	2020 NCQA Quality Compass® National Average (All LOB)
Getting Care
Getting Needed Care Composite (% Always or Usually)	85.88%	84.54%	82.96%
Ease of Getting Needed Care (% Always or Usually)	88.21%	86.26%	85.86%
Ease of Seeing a Specialist (% Always or Usually)	83.54%	82.83%	80.11%
Getting Care Quickly Composite (% Always or Usually)	81.85%	82.88%	82.35%
Ease of Getting Urgent Care (% Always or Usually)	83.02%	83.10%	85.03%
Ease of Getting a Check-Up or Routine Care (% Always or Usually)	80.69%	82.66%	79.82%
Satisfaction with Plan Physicians
Rating of Personal Doctor (% 9 or 10)	68.90%	67.80%	69.24%
Rating of Specialist Seen Most Often (% 9 or 10)	64.97%	67.86%	69.47%
Rating of All Healthcare (% 9 or 10)	57.89%	57.70%	57.67%
Coordination of Care (Always or Usually)	83.11%	83.88%	85.14%
Satisfaction with Plan Services
Rating of Health Plan (% 9 or 10)	60.27%	59.68%	62.23%

Providers directly affect over half of the questions used for scoring. HealthKeepers, Inc. offers an online course for providers and office staff designed to teach how to improve communication skills, build patient trust and commitment, and expand your knowledge of the CAHPS Survey. The Improving the Patient Experience course is available at no cost and is eligible for one continuing medical education (CME) credit by the American Academy of Family Physicians. Providers can access the course at
https://www.mydiversepatients.com/le-ptexp.html.

 

If you have any questions about this communication, call Anthem HealthKeepers Plus, Medallion Provider Services at 800‑901‑0020 or Anthem CCC Plus Provider Services at 855‑323‑4687.

 

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

 

AVA-NU-0542-21

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

 

HealthKeepers, Inc. is transitioning to Availity* Authorization

 

You may already be familiar with the Availity Authorization App because millions of providers are already using it for submitting prior authorization requests for other payers. HealthKeepers, Inc. is eager to make it available to our providers, too. In 2022, you can begin using the same authorization app you may use for other payers. We hope to make it easier than ever before to submit prior authorization requests to HealthKeepers, Inc.

 

Current prior authorization tool (ICR) is still available

 

If you need to refer to an authorization that was previously submitted through the Interactive Care Reviewer (ICR) tool, you will still have access to that information. We’ve developed a pathway for you to access your ICR dashboard. You will simply follow the prompts provided through the Availity Authorization App.

 

Innovation in progress

 

While we grow the Availity Authorization App to provide you with Anthem HealthKeepers Plus-specific information, we’ve provided access to ICR for:

 

• Appeals.
• Behavioral health authorizations.
• FEP authorizations.
• Clinician administered drugs.

Notices in the Availity Authorization App will guide you through the process for accessing ICR for Alternate Authorization/Appeals functions.

 

Training is available

 

If you aren’t already familiar with the Availity Authorization App, training is available.

 

Date	Time (All training sessions are one hour)
Wednesday, January 5, 2022	11 a.m. Eastern
Tuesday, January 11, 2022	3 p.m. Eastern
Thursday, January 20, 2022	Noon Eastern
Tuesday, January 25, 2022	Noon Eastern
Wednesday, January 26, 2022	3 p.m. Eastern

 

You can always log onto https://availity.com and view the webinar at your convenience. From Help & Training, select Get Trained to access the Availity Learning Center. You can use AvAuthRef for a keyword search or select the Session tab to see all upcoming live webinars.

 

Now, give it a try

 

Accessing the Availity Authorization App is easy. Just log onto https://availity.com, and the Authorizations and Referrals icon is on the home screen. You can also access the App through the Patient Registration tab by selecting Authorizations and Referrals.

 

If you have questions, please reach out to Availity at 800-282-4548.

 

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

AVA-NU-0400-21

Please continue to check our website https://providers.anthem.com/virginia-provider/home 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:

 

• Provider orientations and training

 

• Prior authorization updates for medications billed under the medical
  benefit effective March 1, 2022

 

• Prior authorization updates for medications billed under the medical
  benefit

 

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
  update

 

• Change to durable medical equipment wheelchair benefit limits

 

• HEDIS Guide for retinal exam using fundoscopic photograph

The HEDIS^® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality healthcare services. 

 

The ECDS Reporting Standard provides a method to collect, and report structured electronic clinical data for HEDIS quality measurement and improvement. 

 

Benefits to providers:

 

• Reduced burden of medical record review for quality reporting

• Improved health outcomes and care quality due to greater insights for more specific patient-centered care

 

ECDS reporting is part of the National Committee for Quality Assurance’s (NCQA) larger strategy to enable a Digital Quality System and is aligned with the industry’s move to digital measures. 

 

Learn more about NCQA’s digital quality system and what it means to you and your practice, at the following link: https://www.ncqa.org/hedis/the-future-of-hedis/hedis-electronic-clinical-data-system-ecds-reporting/.

 

ECDS measures

 

The first publicly reported measure using the HEDIS ECDS Reporting Standard is the Prenatal Immunization Status (PRS) measure.  In 2022, NCQA will include the PRS measure in Health Plan Ratings for Medicaid and Commercial plans for measurement year 2021.

 

For HEDIS measurement year 2022, the following measures can be reported using ECDS:

 

• Childhood Immunization Status (CIS-E)*
• Immunizations for Adolescents (IMA-E)*
• Breast Cancer Screening (BCS-E)
• Colorectal Cancer Screening (COL-E)
• Follow-Up Care for Children Prescribed ADHD Medication (ADD-E)
• Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM-E)*
• Depression Screening and Follow-Up for Adolescents and Adults (DSF-E)
• Utilization of the PHQ-9 to Monitor Depression Symptoms for Adolescents and Adults (DMS-E)
• Depression Remission or Response for Adolescents and Adults (DRR-E)
• Unhealthy Alcohol Use Screening and Follow-Up (ASF-E)
• Adult Immunization Status (AIS-E)
• Prenatal Immunization Status (PRS-E) (Accreditation measure for 2021)
• Prenatal Depression Screening and Follow-Up (PND-E)
• Postpartum Depression Screening and Follow-Up (PDS-E)

 

* Indicates that this is the first year that the measure can be reported using ECDS.

 

Of note, NCQA added the ECDS reporting method to three existing HEDIS measures: Breast Cancer Screening, Colorectal Cancer Screening and Follow-up Care for Children Prescribed ADHD Medication. Initially, the ECDS method will be optional, which provides health plans an opportunity to try out reporting using the ECDS method before it is required to transition to ECDS only in the future.

 

* HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

ABSCRNU-0288-21

Effective January 1, 2022, IngenioRx/CVS Specialty Pharmacy* will no longer distribute the brand name drug Botox^®. However, Botox will still be available to Anthem Blue Cross and Blue Shield members through other vendors.

 

Please note:

 

• This is not a change in member benefits. This is a change in the Botox vendor only.

 

• If the member is not using IngenioRx/CVS Specialty Pharmacy to obtain Botox, no action is needed.

          

For Botox managed under a Medicare member’s part B (medical) benefit

 

Providers should be using buy and bill for any Medicare member who currently receive Botox through their part B (medical) benefit.  If your patient is receiving Botox using their part B benefit and is receiving their prescription from IngenioRx/CVS Specialty pharmacy, effective January 1, 2022, IngenioRx/CVS Specialty will no longer fill the prescription. As of January 1, 2022, you will need to buy this drug and bill your patient’s health plan.

 

If you have questions regarding a Medicare member’s part B benefits, call Provider Services using the information on the back of the member’s ID card.

 

For Botox managed under a Medicare member’s part D (pharmacy) benefit

 

Effective January 1, 2022, Medicare members who currently receive Botox through IngenioRx/CVS Specialty Pharmacy using their part D (pharmacy) benefit must change to another in-network specialty or retail pharmacy that can obtain and dispense Botox.

 

If you have questions regarding a Medicare member’s part D benefit, call Pharmacy Member Services using the information on the back of the member’s ID card.

 

* IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of Anthem Blue Cross and Blue Shield. CVS is an independent company providing pharmacy services on behalf of Anthem Blue Cross and Blue Shield.

 

ABSCRNU-0289-21

Effective January 1, 2022, Volvo Group North America will offer a Medicare Preferred PPO plan through Anthem Blue Cross and Blue Shield. Retirees with Medicare Parts A and B are eligible to enroll in the local preferred provider organization (LPPO) product. The plan includes the National Access Plus benefit, which allows members to receive services from any provider, as long as the provider is eligible to receive payments from Medicare.

 

The Medicare Advantage plan offers the same hospital and medical benefits that Medicare covers, while covering additional benefits that Medicare does not, such as LiveHealth Online®* and SilverSneakers.®*  Volvo Group North America member copay or coinsurance percentage will be the same whether their provider is in- or out-of-network. Locally or nationwide, doctors or hospitals, member share-of-cost (SOC) doesn’t change.

 

The prefix on Volvo Group North America member ID cards will be VAY. The cards will also show the Volvo Group North America name, along with Medicare Advantage and PPO icons. Providers should follow their normal claim filing procedures for 2022 Volvo Group North America member claims.

 

Claims should not be filed with original Medicare. Contracted and non-contracted providers may call the provider services number on the back of the member ID card for benefit eligibility, prior authorization requirements, and any questions regarding Volvo Group North America member benefits or coverage.

 

Detailed prior authorization requirements also are available to contracted providers by accessing the Availity* Provider Self-Service Tool at https://www.availity.com.

 

If you have questions regarding eligibility, prior authorization requirements, or any questions about the Volvo Group North America member benefits or coverage, call Provider Services at 833-848-8730.

 

* LiveHealth Online is the trade name of Health Management Corporation, an independent company, providing telehealth services on behalf of Anthem Blue Cross and Blue Shield.

Tivity Health, Inc. is an independent company providing the SilverSneakers® fitness program on behalf of Anthem Blue Cross and Blue Shield.

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

 

ABSCRNU-0294-21

Submitting prior authorizations is now easier and multi-payer

 

We know how much easier it is when you have access to digital apps that streamline your work. Thousands of providers already use the Availity* Authorization app to submit prior authorizations for other payers. Now, we want to make it easier to submit prior authorization requests to Anthem Blue Cross and Blue Shield (Anthem) by making the app available in 2022 to our providers as well.

 

Interactive Care Reviewer (ICR) is still available

 

If you need to refer to an authorization that was submitted through the Interactive Care Reviewer, you still have access to that information. We have developed a pathway for you to access your ICR dashboard — You simply follow the prompts provided through the Availity Authorization app.

 

Innovation in progress

 

While we grow the Availity Authorization app to provide even greater functionality and to expand Anthem-specific prior authorizations, we have provided access to ICR for:

 

• Appeals
• Behavioral health authorizations
• Federal Employee Program authorizations
• Medical specialty pharmacy authorizations

 

Notices in the Availity Authorization app will guide you through the process for accessing ICR for these Alternate Authorization/Appeal functions.

 

Begin submitting digital prior authorizations through the Authorization app in 2022

 

If you aren’t already familiar with the Availity Authorization app, live training and recorded webinars are available.

 

Date	Time (All training sessions are one hour)
Wednesday, January 5, 2022	11 a.m. Eastern
Tuesday, January 11, 2022	3 p.m. Eastern
Thursday, January 20, 2022	Noon Eastern
Tuesday, January 25, 2022	Noon Eastern
Wednesday, January 26, 2022	3 p.m. Eastern

 

You can always log onto availity.com to view the webinars at your convenience. From Help & Training, select Get Trained to access the Availity Learning Center. Select the Session tab to see all upcoming live webinars.

 

Tip: To find the authorization training faster, use keyword AvAuthRef in the search field.

Now, give it a try

Eliminate the time and costs associated with faxing prior authorizations by using the Availity Authorization app. It’s easy, convenient, and available when you are, 24/7.

 

Get access by logging onto availity.com. Under the Patient Registration tab, select Authorizations & Referrals. The app is easy to navigate with intuitive functions that walk you through the submission.

 

Tips: You will need to have the Authorization Role assignment in order to access the app and to submit prior authorizations. Your organization’s Availity administrator can assign the role to you.

 

If you have any questions, reach out to Availity at 800-282-4548.

 

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

 

ABSCRNU-0267-21

Please continue to read news and updates at anthem.com/medicareprovider for the latest Medicare Advantage information, including:

 

• Medical step therapy updates

 

• Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list

 

• AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines
  update