The National Accounts 2023 Precertification list has been published.

Please note, providers should continue to verify member eligibility and benefits prior to rendering services.

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Understanding how to use the many time saving applications on Availity Essentials* is important to working together digitally. Anthem Blue Cross and Blue Shield has developed a learning place just for that purpose — the Provider Learning Hub.

Using the Provider Learning Hub available from anthem.com/provider is the easiest and quickest way to access courses and learning guides about claim submission, attachments and status, eligibility and benefits, and more.

These new and improved learning experiences apply to Availity Essentials and electronic data interchange (EDI) transactions:

• Visit the Provider Learning Hub for short, easy-to-follow training videos with supporting resources — no username and password required.
• Handy filtering options make it easy to find what you are looking for.
• The Favorites folder lets you save courses for easy access later.
• Register once and on future visits your preferences are populated, eliminating the need for any additional logon information.

Get started today!

Access the Provider Learning Hub today using this link or from anthem.com/provider under Important Announcements on the home page.

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

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Submit updates and corrections to your directory information using our online Provider Maintenance Form. Online update options include:

• Add/change an address location.
• Name change.
• Tax ID changes.
• Provider leaving a group or a single location.
• Phone/fax number changes.
• Closing a practice location.

Once you submit the form, we will send you an email acknowledging receipt of your request.

The Consolidated Appropriations Act (CAA) contains a provision that requires online provider directory information be reviewed and updated (if needed) at least every 90 days. By reviewing your information regularly, you can help us ensure your online provider directory information is current.

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We understand that submitting authorizations by phone or fax is time consuming and inefficient. We have a digital application, Interactive Care Reviewer (ICR), that makes it easy to submit, review, and check authorization status all in one place, electronically.

We’d like to invite you to a webcast that covers how to:

• Access ICR.
• Create an authorization request.
• Inquire on a previously submitted authorization.
• Update a case.
• Copy a case.
• View letters associated with a case.
• Request and check the status of an authorization appeal.

Join us for an ICR learning webcast:

• Wednesday, October 12, 2022, at 11 a.m. Eastern time
• Register here

Visit the ICR Target page to register and to access self-service learning by viewing recorded learning sessions. Download ICR user guides and other job aides from the ICR Target page too.  You can also register from the Provider Learning Hub by clicking on the ICR live webinar learning icon.

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Care providers are a trusted resource for members when it comes to vaccine advice. As information on the monkeypox outbreak changes and vaccination and testing guidance is released, we’re committed to keeping you informed.

Some care providers may have seen a message on their provider Explanation of Benefits (EOB) stating that Anthem does not recognize the vaccine product codes for monkeypox and smallpox that became effective July 26, 2022. We’re updating the provider fee schedules to reflect the new vaccine product codes as quickly as possible. The EOB message did not impact payment for administration of the vaccines, which is reimbursable; however, since the monkeypox and smallpox vaccines are provided by the government at no charge, the vaccine products are non-reimbursable.

To aid in processing claims for the monkeypox and smallpox vaccine products, care providers must include these three elements on claims, even if vaccine products were received from the federal government at no charge:

1. Product code (90611 or 90622)
2. Applicable ICD-10-CM diagnosis code
3. Administration code

More detail on codes and cost-sharing

Providers are encouraged to use:

• Product code 90611 for smallpox and monkeypox vaccine.
• Product code 90622 for vaccinia (smallpox) virus vaccine.
• Code 87593 for laboratory testing.

When billing the monkeypox and smallpox vaccine products, care providers should submit those codes with a $0.01 charge.

Cost-sharing for the vaccine is waived.

If you have any questions, contact the Provider Service number on the back of the member’s ID card. You can read more information on monkeypox here.

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Please continue to check Provider Communications & Updates on the provider website for the latest BadgerCare Plus information, including:

• New specialty pharmacy medical step therapy requirements
  
  
• Prior authorization updates for medications billed under the medical benefit-1
  
  
• Prior authorization updates for medications billed under the medical benefit-2
  
  
• Change to claims acceptance based on Clinical Laboratory Improvement Amendments
  
  
• MCG 26th Edition Update – Added to the October 2022 edition of Ohio's Provider News on October 11, 2022.

In the October 2021 edition of the provider newsletter, we announced that a new reimbursement policy titled Sexually Transmitted Infections Testing — Professional would be effective for dates of service on or after January 1, 2022. We have made a decision to retract this reimbursement policy.

If you have any questions, contact your Provider Experience associate or visit the Contact Us page on our provider website for up-to-date contact information.

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In line with our commitment to participating practitioners and members, Anthem Blue Cross and Blue Shield has a Members’ Rights and Responsibilities section located within the provider manual. The delivery of quality healthcare requires cooperation between patients, their providers, and their healthcare benefit plans. One of the first steps is for patients and providers to understand their rights and responsibilities.

Review this section in your provider manual here: https://providers.anthem.com/docs/gpp/WI_CAID_Provider_Manual.pdf?v=202205162311

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The best source of up-to-date information is at the Centers for Disease Control and Prevention which has a dedicated monkeypox page for healthcare professionals.

In addition to resources for care providers, the CDC has developed educational materials for the public, available for free download online.

FAQs

How does monkeypox spread?

Monkeypox does not spread easily between people without close contact. Person-to-person transmission is possible by skin-to-skin contact with body fluids or monkeypox sores, or respiratory droplets during prolonged face-to-face contact, and less likely through contaminated items such as bedding, clothing, or towels. Patients are contagious until the scabs heal and are replaced by new skin.

How dangerous is the disease?

Monkeypox virus belongs to the poxvirus family and infection is rarely fatal. Patients whose immune system is compromised are most at risk for severe disease, along with children younger than 8 years old, pregnant and breastfeeding people, and people with a history of atopic dermatitis or other active skin conditions.

What are monkeypox symptoms?

Patients often have a characteristic rash (well-circumscribed, firm, or hard macules evolving to vesicles or pustules) on a single site on the body. Patients may also present with a fever and muscle aches. The rash may start in the genital and perianal areas. The lesions are painful when they initially emerge, but can become itchy as they heal, and then go away after two to four weeks. Symptoms can be similar or occur at the same time as sexually transmitted infections.

Is there a monkeypox vaccine?

Yes, although at the time of this writing, availability is limited. Smallpox and monkeypox vaccines are effective at protecting people against monkeypox when given before exposure to monkeypox, and vaccination after a monkeypox exposure may help prevent the disease or make it less severe. You can access the CDC’s vaccination updates online.

How can monkeypox be treated?

There are no treatments specifically for monkeypox virus infections. However, antiviral drugs and vaccines developed to protect against smallpox may be used to prevent and treat monkeypox virus infections.

Do I need to report a case of suspected monkeypox?

Yes, contact your state health department if you have a patient with monkeypox. They can help with testing and exposure precautions. Find your state health plan department online.

What are the behavioral health impacts of monkeypox?

Studies reporting psychiatric symptoms have indicated that the presence of anxiety, depression, or low mood is common among hospitalized patients with monkeypox infection. Care providers can help by listening with compassion, understanding underlying behavioral health concerns that may be heightened during isolation, and refer patients to the appropriate level of support following a monkeypox diagnosis.

What if I need assistance?

If you have questions about this communication or need assistance with any other item, visit the Contact Us section at the bottom of our provider website for up-to-date contact information or call Provider Services at 855-558-1443.

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• Medicare telehealth services during the Coronavirus (COVID-19) public health emergency (PHE) FAQ
  
  
• Anthem expands specialty pharmacy precertification list-1
  
  
• Anthem expands specialty pharmacy precertification list-2
  
  
• Consultation codes
  
  

• MCG 26th Edition Update – Added to the October 2022 edition of Ohio's Provider News on October 11, 2022.

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In the October 2021 edition of the provider newsletter, we announced that a new reimbursement policy titled Sexually Transmitted Infections Testing — Professional would be effective for dates of service on or after January 1, 2022. We have made a decision to retract this reimbursement policy.

If you have any questions, contact your Provider Experience associate or visit the Contact Us page on our provider website for up-to-date contact information.

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