 Provider News WisconsinJanuary 2022 Anthem Provider News - WisconsinAn updated BlueCard ® Program Provider Manual is available on our public provider website January 1, 2022. The manual includes enhanced content and should be helpful in understanding the BlueCard ® 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 anthem.com, select Provider Overview and Wisconsin as your state. From the horizontal menu, select “Policies, Guidelines and Manuals” under Provider Resources. Scroll down to the Provider Manual Library section and select the “BlueCard Provider Manual”.
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 Prevention2 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-10:110, 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
You may already be familiar with the Availity multi-payer Authorization app because thousands of providers are already using it for submitting prior authorizations for other payers. Anthem Blue Cross and Blue Shield (Anthem) is eager to make it available to our providers, too. In 2022, you can begin using the same authorization app you use for other payers. We hope to make it easier to submit prior authorization requests to Anthem.
ICR is still available
If you need to refer to an authorization that was submitted through ICR, you will still have access to that information. We’ve developed a pathway 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-specific information, you can still access ICR for:
- Appeals
- Behavioral health authorizations
- FEP authorizations
- Medical specialty Rx
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.
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Wednesday, January 5, 2022
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10 a.m. CT
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Tuesday, January 11, 2022
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2 p.m. CT
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Thursday, January 20, 2022
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11 a.m. CT
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Tuesday, January 25, 2022
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11 a.m. CT
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Wednesday, January 26, 2022
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2 p.m. CT
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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. You can also log onto Availity.com and view the webinar at your convenience.
Now, give it a try!
Accessing the Availity Authorization app is easy. Just log onto Availity.com and the Authorization icon is on the home screen. You can also access the app through the Patient Registration tab by selecting Authorizations and Referrals.
When you use the Availity Authorization app, you will know if a prior authorization is required in six easy steps and in fewer than five minutes. If a prior authorization is not needed, the message “No Auth Required” will return. This submission will be saved to your dashboard for future reference. If authorization is needed, just continue with the prior authorization submission. The entire submission process takes less time than it would to send an authorization by fax and is much quicker than chatting with provider services.
Did you know that digital authorizations are considered a high priority? Submitting your pressing authorizations through the Availity Authorization app augments our process, helping to reduce unnecessary delays to your patient’s care.
You can now submit prior authorizations in one place for all payers. The Availity Authorization app is multi-payer. This means you no longer have to toggle between Anthem Blue Cross and Blue Shield (Anthem)’s Interactive Care Recorder (ICR) and the Availity Authorization app to submit apps for all payers.
AIM authorization for radiology services? No problem! The Availity Authorization app is set up for radiology service authorization submissions. Coming later in 2022, you can submit all of your AIM authorizations through the app.
Access the Availity Authorization app for Anthem submissions in 2022. Log onto Availity.com and select the Authorizations app from the home screen or use the Patient Registration tab to select Authorizations & Referrals through the multi-payer app.
ICR is still accessible to review previously submitted authorizations. You will also continue to use ICR for behavioral health authorizations, FEP authorizations and authorizations for medical specialty Rx. Until we fully integrate Anthem-specific functions in the Availity Authorization app, you will also continue to use ICR for appeals as well.
How do you access ICR? That’s easy, too. We have added a landing page in the Availity Authorization app that offers a direct link to your ICR dashboard. Just select the Alternate Authorizations/Appeals button on the landing page.
Not familiar with the Availity Authorization app? Training is convenient and available through live webinars or recorded sessions for self-service learning. To sign-up for training log onto Availity.com and from the top toolbar select Help & Training then Get Trained. Use “AvAuthRef” in the search bar or select the Session tab to see all upcoming live webinars.
Availity Authorization app training schedule:
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Wednesday, January 5, 2022
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10 a.m. CT
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Tuesday, January 11, 2022
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2 p.m. CT
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Thursday, January 20, 2022
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11 a.m. CT
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Tuesday, January 25, 2022
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11 a.m. CT
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Wednesday, January 26, 2022
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2 p.m. CT
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Now, give it a try! If you’re not enrolled on Availity go to Availity.com/provider-portal-registration. Availity is free to Anthem providers, saves time, reduces costs and offers a seamless digital transaction experience.
*Material Adverse Change (MAC)
For dates of service on and after April 1, 2022, Anthem Blue Cross and Blue Shield (Anthem) will apply multiple imaging reimbursement rules to the technical component of diagnostic imaging procedures. These rules apply across diagnostic imaging families, and modalities of radiology procedures and are not limited to contiguous body areas.
Multiple imaging reimbursement rules are applied to the maximum allowance for the Technical Component (TC) of the following diagnostic imaging procedures rendered on the same date of service and eligible for reimbursement:
- Ultrasound, computed tomography (CT)
- Computed tomographic angiography (CTA)
- Magnetic resonance imaging (MRI)
- Magnetic resonance angiography (MRA)
When two or more imaging procedures are performed in the same facility on the same patient on the same date of service, reimbursement is:
- 100% of the highest facility allowance for the first imaging procedure for the date of service.
- 50% of the facility allowance for each subsequent imaging procedure for that date of service.
Please review the policy in its entirety for more detailed information. For more information about this policy, visit the Reimbursement Policy page at anthem.com.
To view the 2022 benefits and changes for the Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program® (FEP), go to fepblue.org then click Tools & Resources at the top of the page, and then click Brochures & Resources. Here you will find Plan Brochures, Plan Summaries, and Quick Reference Guides on information for year 2022.
For questions please contact FEP Customer Service at (800) 242-9635.
The Behavioral Health Areas of Expertise Profile (BHAEP) is designed to highlight your behavioral health network providers’ services, cultural preferences, race, languages spoken, and other specialties to our members through the enhancement of our online provider directory. The goal is to help our members find the right behavioral health provider to fit their unique needs.
Contracted Medicaid providers are asked to answer a brief online survey on their clinical areas of expertise, demographics, modalities, and accessibility. The data collected provides insight into our behavioral health providers’ capabilities, which assists in member referral, provider network strategy development, and proposal support. Completion of the BHAEP does not affect a provider’s credentialing materials/status or contract.
By capturing this information, we are able to:
- Improve identification of specific services and/or specialties.
- Improve the referral process by better identifying provider capabilities.
- Align with competitors that provide this data in their online provider directories.
Currently, the BHAEP is administered in 18 Medicaid markets. The local health plan completes provider outreach. While data gathered through this tool has proven to be helpful to members, providers, and the health plan, response rates remain low.
View your State’s BHAEP survey here.
AWI-NU-0330-21 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 Blue Cross and Blue Shield (Anthem) members through buy and bill.
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 Anthem.
If you have questions regarding a member’s medical specialty pharmacy benefits, call Provider Services at 855-558-1443.
This communication applies to the Medicaid and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem).
The HEDIS® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care 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.
This communication applies to the Medicaid and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem).
Anthem is transitioning to the Availity Authorization app
You may already be familiar with the Availity multi-payer Authorization app because thousands of providers are already using it for submitting prior authorizations for other payers. Anthem Blue Cross and Blue Shield (Anthem) is eager to make it available to our providers, too. In 2022, you can begin using the same authorization app you use for other payers. We hope to make it easier to submit prior authorization requests to Anthem.
ICR is still available
If you need to refer to an authorization that was submitted through ICR, you will still have access to that information. We’ve developed a pathway 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-specific information, you can still access ICR for:
- Appeals
- Behavioral health authorizations
- FEP authorizations
- Medical specialty Rx
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.
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Date
|
Time
|
|
Wednesday, January 5, 2022
|
10 a.m. CT
|
|
Tuesday, January 11, 2022
|
2 p.m. CT
|
|
Thursday, January 20, 2022
|
11 a.m. CT
|
|
Tuesday, January 25, 2022
|
11 a.m. CT
|
|
Wednesday, January 26, 2022
|
2 p.m. CT
|
You can always log onto 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 availity.com and the Authorization icon is on the home screen. You can also access the app through the Patient Registration tab by selecting Authorizations and Referrals.
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 (Anthem) 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 filled 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.
The HEDIS® Electronic Clinical Data Systems (ECDS) reporting methodology encourages the exchange of the information needed to provide high-quality health-care 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.
This communication applies to the Medicaid and Medicare Advantage programs for Anthem Blue Cross and Blue Shield (Anthem).
Anthem is transitioning to the Availity Authorization app
You may already be familiar with the Availity multi-payer Authorization app because thousands of providers are already using it for submitting prior authorizations for other payers. Anthem Blue Cross and Blue Shield (Anthem) is eager to make it available to our providers, too. In 2022, you can begin using the same authorization app you use for other payers. We hope to make it easier to submit prior authorization requests to Anthem.
ICR is still available
If you need to refer to an authorization that was submitted through ICR, you will still have access to that information. We’ve developed a pathway 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-specific information, you can still access ICR for:
- Appeals
- Behavioral health authorizations
- FEP authorizations
- Medical specialty Rx
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
|
|
Wednesday, January 5, 2022
|
10 a.m. CT
|
|
Tuesday, January 11, 2022
|
2 p.m. CT
|
|
Thursday, January 20, 2022
|
11 a.m. CT
|
|
Tuesday, January 25, 2022
|
11 a.m. CT
|
|
Wednesday, January 26, 2022
|
2 p.m. CT
|
You can always log onto 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 availity.com and the Authorization icon is on the home screen. You can also access the app through the Patient Registration tab by selecting Authorizations and Referrals.
|