Have you had more patients present with their ID card on their smartphone? We want to remind you of the ways you can access your own copy of their ID card.

In the October 2017 issue of Network Update (see page 20), Anthem Blue Cross and Blue Shield informed you about our mobile app called Anthem Anywhere that allows members to manage their benefits on their smart phones, including the option of an electronic only version of their ID cards.  We want to ensure a member’s electronic only ID card meets your needs. 

Based on member requests and growing trends, we anticipate that by the year 2020, nearly 50% of our Local Plan members may choose the electronic ID card option, so we urge you to start using the available retrieval tools today. 

Provider options for obtaining a copy of an electronic Member ID card

• Online – through the Availity Portal  
  
  Providers also have the option to view Anthem Member ID Cards online (and print if needed) from the Availity Portal at availity.com.  When conducting an eligibility and benefits (E&B) inquiry -- from the E&B Results page, select the blue button titled View Member ID Card  .  [Currently excludes BlueCard®, Federal Employee Program® (FEP) and some health plans’ Medicare Advantage and Medicaid members.]
  
  
  
  
  
  

Note: as with all E&B inquiries on Availity, providers must have the member ID number (including the three-character prefix) and one or more search options of date of birth, first name and last name.

• Email or Fax  
  
  Members can email/fax the card from his/her phone.  When members are viewing their ID Card on their phone, they will select the email or fax icon to forward their ID card.
  
  

These options are available for your patients who are members covered by our affiliated health plans in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, Nevada, Ohio, Wisconsin, Virginia, and New York. 

Members are still required to have a copy of their card in one format or another, whether hard copy or electronic, in order for services to be rendered.  See our Quick Reference Guide for further details.

Quick Reference Guide

See our Electronic Member ID Cards – Quick Reference Guide for more details and information on:

• Frequently Asked Questions
• Details on provider options for obtaining a copy of an electronic Member ID card
• Sample electronic Member ID cards

Our provider newsletter is our primary source for providing important information to health care providers and professionals. The newsletter 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 to this newsletter and our website, we also use our email service – Network eUPDATE – to communicate new information. If you are not yet signed up to receive Network eUPDATEs, 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 newsletter 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 sign up – just select Virginia and access the provider home page.  There, you’ll find a link to register for our Network eUPDATE.  

Maintaining accurate provider information is critically important to ensure that our members have timely access to care. Updated information helps us maintain accurate provider directories and also ensures that providers are more easily accessible to members. Additionally, Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. are required by Centers for Medicare & Medicaid Services (CMS) to include accurate information in provider directories for certain key provider data elements.  CMS routinely reviews/audits our provider directories for accuracy and completeness.

Since it is the responsibility of each provider to inform insurance health plans when there are changes, providers are reminded to notify Anthem of any changes to their demographic information or other key pieces of information, such as a change in their ability to accept new patients, street address, phone number or any other change that affects patient access to care. For Anthem to remain compliant with federal and state requirements, changes must be communicated within 30 days in advance of a change or as soon as possible so that members have access to the most current information in our provider directory.

Key data elements

The data elements required by CMS and crucial for member access to care are: 

• Physician Name
• Location (such as address, suite if appropriate, city/state, zip code)
• Phone Number
• Accepting New Patient Status
• Hospital Affiliations
• Medical Group Affiliations

Anthem is also encouraged (and in some cases required by certain regulatory/accrediting entities) to include accurate information for the following provider data elements:

• Physician Gender
• Languages Spoken
• Office Hours
• Specialties
• Physical Disabilities Accommodations (e.g., wide entry, wheelchair access, accessible exam rooms and tables, lifts, scales, bathrooms and stalls, grab bars, other accessible equipment)
• Indian Health Service Status
• Licensing information (i.e., Medical License Number, License State, National Provider Identifier NPI)
• Provider Credentials (i.e., Board Certification, Place of Residency, Internship, Medical School, Year of Graduation)
• Email and website address
• Hospital has an emergency department, if applicable

If you have questions about updating your demographic information, contact your Anthem network manager.

In the March 2019 edition of our provider newsletter, we announced the updates we’ve made to the Medical Attachment submission tool. As you start using the updated Medical Attachment tool on the Availity Portal, you will notice the following changes from the information we shared in March:

• File size – each attachment can be up to 10 MB with a maximum of 30 MB as the file size limit.

• The addition of logos in your dashboard make it easy to quickly identify each payer.

• The Medical Attachment tool will be retired from the Availity Portal soon, so we encourage you to start using the “Attachment – New” option now. (We will notify you once a retirement date is determined for the Medical Attachment tool.)

Other features of the updated Medical Attachment tool include:

• The ability to submit an itemized bill.

• A different link titled “Attachment – New” where you will now submit medical records when Anthem has requested additional information to process a claim.

• A new link on the attachment page called “Send Attachment” will allow you to start the process.

• A record history of each entry provides you increased visibility of your submission.

The Medical Attachment tool makes the process of submitting electronic documentation in support of a claim simple and streamlined. You can use your tax identification number (TIN) or your National Provider Identifier (NPI) to register and submit solicited (requested by Anthem) medical record attachments through the Availity Portal.

NOTE: We will continue to keep you informed of upcoming changes to the ‘Attachment – New’ platform, as we continue to work to streamline our electronic documentation functionality.

How to Access solicited Medical Attachments for Your Office

• Availity Administrator, complete these steps:

From My Account Dashboard, select Enrollments Center>Medical Attachments Setup, follow the prompts and complete the following sections:

1. Select Application>choose Medical Attachments Registration.

2. Provider Management>Select Organization from the drop-down. Add NPIs and/or Tax IDs (Multiples can be added separated by spaces or semi-colons).

3. Assign user access by checking the box in front of the user’s name. Users may be removed by unchecking their name.

Using Medical Attachments

Availity User, complete these steps:

1. Log in to www.availity.com
2. Select Claims and Payments > Attachments-New >Send Attachment tab
3. Complete all required fields of the form
4. Attach supporting documentation
5. Submit

Need Training?

To access additional training for this Availity feature:

1. Log in to the Availity Portal at www.availity.com
2. Select Help and Training > Get Trained to open the Availity Learning Center (ALC) catalog in a new browser tab. It is your dedicated ALC account.
3. Search the Catalog by keyword (attachments) to find training demo and on-demand courses.
4. Select Enroll to enroll for a course and then go to your Dashboard to access it any time. 

Anthem Blue Cross and Blue Shield (Anthem) has identified an increasing trend in the billing of emergency room (ER) level 5 Evaluation and Management (E/M) codes. To help manage increasing health care costs, beginning August 1, 2019, Anthem will initiate the post-pay review of professional ER claims billed with level 5 E/M Codes (99285 or G0384) to ensure documentation meets or exceeds the components necessary to support its billing. Professional ER claims with the highest potential for up-coding will be selected.

Anthem will request documentation for identified claims, and level 5 ER professional reviews will evaluate the appropriate use of the level 5 ER code based on the AMA CPT coding manuals, and Anthem guidelines. Reimbursement will be based on the ER E/M code the submitted documentation supports.

As a contracted provider with Anthem Blue Cross and Blue Shield in Virginia, please remember that you are obligated when medically appropriate to refer Anthem members to in-network providers.  This includes physicians and all provider types including, but not limited to, ambulance transport (ground and air), ambulatory surgical centers, behavioral health services, physical medicine providers and ancillary providers.  Referring to in-network providers allows members to receive the highest level of benefits under their Health Benefit Plan.  As a reminder, call Anthem first for precertification if required by the member’s policy. 

Ground ambulance providers

You can search for participating ground providers using our online tool, Provider Finder, located at www.anthem.com. Search parameters include distance from your location (zip code, address or county). To use the tool, go to www.anthem.com and follow these steps in our “Find a Doctor” tool:

1. Select “all plans/networks”
2. Select type of coverage
3. I am looking for a : “other medical services”
4. Who specializes in: “ambulance companies”
5. Located near: add your address, zip or county

Air ambulance providers

The providers listed below are participating air ambulance providers with Anthem in Virginia.  This means that these providers have contractually agreed to accept the Anthem rate as payment in full for covered services, and they will bill members only for allowable benefit cost-share obligations when transporting members who are picked up in Virginia. 

Some air ambulance providers choose not to participate with payers like Anthem.

• These air ambulance providers may charge members rates that are much higher than the Anthem contracted provider rates.

• Depending on their benefits, members who utilize non-participating air ambulance providers can be left with significant out-of-pocket expenses, which the ambulance providers and their billing agents may seek to collect.

To avoid these situations, we ask that, whenever possible, you use a participating air ambulance provider for your patients who are our 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 contact Anthem for precertification if required by the member’s policy, then call one of the phone numbers listed below. Please have the following information ready when you call:

• Basic medical information about the patient, including the patient’s name and date of birth or age.  If the service was not pre-certified 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 time frame.

• 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 provider network manager.  To arrange air transport originating outside the U.S., U.S. Virgin Islands and Puerto Rico, call 800-810-BLUE for BCBS Global Core formerly BlueCard Wordwide.

Virginia Air (FW and Rotary) Providers

Fixed Wing (Airplane) Providers (HCPCS Codes: A0430 and A0435)

Rotary Wing (Helicopter) Providers

(HCPCS Codes: A0431 and A0436)

In late May, Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. will begin mailing network-participating professional providers information regarding changes to our existing provider agreements.  Along with changes to the provider agreements, we are updating our fee schedules, reimbursement policies and provider manual.  These changes will be effective September 1, 2019.  Professional providers who currently contract with Anthem and/or HealthKeepers, Inc. should receive an amendment to their existing provider agreements.  The amendments will be mailed on a computer disc (CD).

To continue network participation, no action will be required.  Providers who expect to receive an amendment package and do not do so by June 3, 2019, should contact their Anthem network manager to obtain a copy.

DME fee schedule adjustment

In a continuation of our CRA reporting update articles throughout 2019, Anthem Blue Cross and Blue Shield requests your assistance with respect to our Commercial Risk Adjustment (CRA) reporting processes.

As a reminder, there are two approaches that we take (Retrospective and Prospective) to improve risk adjustment reporting accuracy.  We are focusing on performing appropriate interventions and chart reviews for patients with undocumented Hierarchical Condition Categories (HCC), to close the documentation and coding gaps that we are seeing with our members enrolled in our Affordable Care Act (ACA) compliant plans.

This month, we’d like to focus on the Prospective approach and the request to our providers:

Anthem network providers -- usually primary care physicians -- may receive letters from our vendor, Inovalon, requesting that physicians:

1. Schedule a comprehensive visit with patients identified to confirm or deny if previously coded or suspected diagnoses exist, and

2. Submit a Health Assessment documenting the previously coded or suspected diagnoses (also called a SOAP Note -- Subjective, Objective, Assessment and Plan).

Incentives for properly submitted health assessments (in addition to the office visit reimbursement):

• $100 submitted electronically

• $50 submitted via fax

Health assessment requests through Inovalon

We have engaged Inovalon -- an independent company that provides secure, clinical documentation services -- to help us comply with provisions of the ACA that require us to assess members’ relative health risk level.  In the coming weeks and months, Inovalon will be sending letters to providers as part of our risk adjustment cycle, asking for their help with completing health assessments for some of our members.

This year will bring a new round of assessments. As a reminder, chronic conditions must be coded every year, and we encourage you to code to the greatest level of specificity on all Anthem claims submissions.  If you have questions about the requests you receive, you can reach Inovalon directly at 1-866-682-6680.

Maximize your incentive opportunity: Submit electronically via Inovalon’s ePASS® tool

Join an ePASS webinar to learn how to submit a health assessment electronically and maximize your incentive opportunities.  Webinars are offered every Wednesday from 3 to 4 p.m. ET.  Register by sending an email to ePASSProviderRelations@inovalon.com with your name, organization, contact information and the date of the webinar you wish to attend.

• Teleconference: Dial 1-415-655-0002 (US Toll) and enter access code: 736 436 872

• WebEx: Visit https://inovalonmeet.webex.com and enter meeting number: 736 436 872

• Once you join the call, live support is available at any time by dialing *0

Alternative reporting engagement

ePASS is our preferred method for submission for the Prospective approach. However, to improve engagement and to collaborate with our providers who are not submitting via ePASS, we have identified other alternatives which may be helpful and provide more flexibility with your current processes.

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

Modifier 63: Procedure Performed on Infants Less Than 4 kg – Policy 06-015

76050MUPENMUB

New incentive program for reimbursement for select CPT Category II codes

Latest updates to Electronic Data Interchange Gateway migration

Medicare Advantage Group Retiree PPO plans and National Access Plus FAQ 

Group Retiree members and National Access Plus

Prior authorization requirements for DME repair and portable oxygen
 

New provider learning opportunity: Put the AIM ProviderPortal to work for you

75975MUPENMUB

Each year, falls result in more than 2.8 million ER visits; 800,000 hospitalizations; and 27,000 deaths. Additional information about helping patients enrolled in Medicare Advantage prevent falls is available online. Check out the fall prevention tips.   

76195MUPENMUB

Medicare Advantage plans under Anthem Blue Cross and Blue Shield follow original Medicare guidelines and billing requirements for partial hospitalization services. The Centers for Medicare & Medicaid Services’ (CMS) regulations (42 CFR 410.43(c)(1)) state that partial hospitalization programs (PHPs) are intended for members who require a minimum of 20 hours per week of therapeutic services as evidenced in their plan of care. All partial hospitalization services require prior authorization. Check out the full article online, partial hospitalization services. 

76175MUPENMUB

In 2019, Anthem will work with Optum, using their copy partner CiOX, to request medical records with dates of service for the target year 2018, through present day, then review and code the record. Read more.

Additional information, including frequently asked questions and answers, will be available at www.anthem.com/ca/medicareprover > Important Medicare Advantage Updates.

Learn more online about the authorization changes for procedure codes.

On August 17, 2018, October 9, 2018, and November 16, 2018, the pharmacy and therapeutic (P&T) committee approved Clinical Criteria applicable to the medical drug benefit for Anthem HealthKeepers Plus members. These policies were developed, revised or reviewed to support clinical coding edits.

The Clinical Criteria is publicly available on our provider website, and the effective dates are reflected in the Clinical Criteria updates notification. Visit the Clinical Criteria website to search for specific policies.

Email for questions or additional information.