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Network Update

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Network Update is an Anthem Blue Cross and Blue Shield newsletter sent to our Colorado network providers each month. Start receiving Network Update and all Anthem network communications via email, click Anthem Network eUpdate Registration Form to sign up TODAY!

 
Drug fee schedule update
Claim Edits to Support Correct Coding Principles for CMS 1500 submitters will apply to BlueCard Host Claims Effective June 16, 2017
Updated Inovalon ePASS® webinar schedule for July, August and September
Updated Escalation Contact List
Update to Claims Processing Edits and Reimbursement Policies
Medicare Advantage Updates

Request expedited organization determinations

Anthem follows CMS guidelines for clinical trial-related claims

Include NPI on surgical procedure UB04 bills

Keep up with Medicare news

Health Care Reform Updates and notifications

Coverage Update for 3D Screening Mammograms – June 2017

 
New Member Identification Prefixes coming in 2018
Important Announcement: Risk Adjustment Data Validation Audit
Upcoming Re-Credentialing Event? Re-attest to your CAQH ProView profile today
Credentialing News
835 Electronic Remittance Advices for Cashless Payments versus Zero Paid
Anthem E-Solutions Service Desk supports EDI direct submitters
Interactive Care Reviewer (ICR) training opportunities
Diabetic Retinal Eye Exam
Updated Escalation Contact List
Updated Alpha Prefix Reference List
Update to Claims Processing Edits and Reimbursement Policies
Pharmacy information available on anthem.com
Medicare Advantage Updates

Home Health Services for Medicare Advantage Individual Members to Require Prior Authorization

No copay benefit for diabetes retinal exam and HbA1c testing effective January 1, 2017

Tips for submitting Medicare Advantage corrected claims

HCPCS codes allow for payment for coordinating behavioral health services

Use code 1111F to receive reimbursement for post-discharge medication reconciliation

Imaging services providers must complete OptiNet® assessments to avoid line-item denials

Keep up with Medicare news

Health Care Reform Updates and notifications
 
New Program for the Colorado Market
Introducing Patient360 – Get quick and easy access to your Anthem member records
Updated Inovalon ePASS® webinar schedule
Reminder: Members managed by OrthoNet available online through Availity Web Portal
OrthoNet Quick Reference Guide
Clinical Practice and Preventive Health Guidelines Available online
HEDIS® 2017: What’s new?
Update to Claims Processing Edits and Professional Reimbursement Policies
Medicare Advantage Updates

Home health services for Medicare Advantage individual members require prior authorization

Home health services for Medicare Advantage individual members require prior authorization

Tetanus vaccine billing guidelines

Keep up with Medicare news

Health Care Reform Updates and notifications
 
Drug fee schedule update
Important upcoming changes to Anthem National Drug List (formulary)
Spring Provider Seminars: Special Topic – Commercial Risk Adjustment for ACA members
Remittance Inquiry search option streamlined on Availity – Check it out!
Updated Escalation Contact List
Updated Alpha Prefix Reference List
Non-participating lab referrals
Try the Interactive Care Reviewer (ICR) to submit pre-certification requests online today!
New Program for the Colorado Market
Update to Claims Processing Edits and Professional Reimbursement Policies
Pharmacy information available on anthem.com
Integrated Care Model for plans purchased on Connect for Health Colorado benefits members and physicians
ConditionCare Program Benefits Members and Physicians
Medicare Advantage Updates

AIM OptiNet services initiative postponed until May 1, 2017

Review high-risk medication reports

AccordantCare™ to provide support for Individual Medicare Advantage members with HIV

Medicare Supplement – please wait 30 days from Medicare remittance date before submitting another claim

Keep up with Medicare news

Health Care Reform Updates and notifications

Anthem provides new or additional evidence considered during an appeal

 
After Hours Reminder
Importance of submitting Provider changes timely
Medical chart reviews for members with plans on or off the exchange due by April 1, 2017
Updated Escalation Contact List
Medicare Advantage Updates

Coding patient services reminders

Preventive service procedure codes updated for 2017

CMS releases new coding guidelines for 3D mammography

Comply with clinical information requests

New G codes for home health agencies

New place of service code 02 for telehealth services

Keep up with Medicare news

Health Care Reform Updates and notifications
 
SOAP Notes/Health Assessments requested by Inovalon for 2016 calendar year must be submitted by February 10, 2017
Members managed by OrthoNet available online through Availity Web Portal
Reminder: ProviderAccess Web Portal Retirement Delayed
Use the Interactive Care Reviewer via the Availity Web Portal to submit your requests for Behavioral Health services today!
Member satisfaction with Behavioral Health outpatient services
Commercial HEDIS® 2017 starts early February
Blood Pressure Monitor Benefits for Federal Employees
Free provider training and CME credit – Moving toward equity in asthma care
Practitioners’ rights during the credentialing process
Blue Physician Recognition and Physician Quality Measurement programs to sunset
Update to Claims Processing Edits and Professional Reimbursement Policies
Clinical Practice and Preventive Health Guidelines Available online
Pharmacy information available on anthem.com
Medicare Advantage Updates

Update to Claims Processing Edits and Professional Reimbursement Policies

New CMS requirement – hospitals must use Medicare Outpatient Observation Notice (MOON) form

Retrospective medical record review program launches

Radiation therapy services – contact AIM for delivery, Anthem for planning

Keep up with Medicare news

Health Care Reform Updates and notifications

Preventive care services covered with no member cost-share (updated December 2016)

 
Drug fee schedule update
Provider Solutions contact updates
Updated Escalation Contact List
Updated Alpha Prefix Reference List
ProviderAccess Retirement delayed: Still encouraged to transition to the Availity Web Portal Now
Use the Interactive Care Reviewer (ICR) to submit and check the precert status for many of your Anthem patients today!
Clinical Practice and Preventive Health Guidelines Available on the Web
Reminder: Provide Anthem with advance written notice when acquiring, being acquired by, or merging / assigning with another provider
Reminder: Webinars by Inovalon help you complete SOAP Notes for 2016 calendar year by February 10, 2017
Update to Claims Processing Edits and Professional Reimbursement Policies
Clinical Practice and Preventive Health Guidelines available online
Medicare Advantage Updates

Claim adjustments may change member cost share

Payment reduction for X-rays taken using film

Claims for tetanus vaccinations

Individual MA members should use Hearing Care Solutions

Include NPI in surgical procedure bills

Transitional Care Management (TCM) Services

Keep up with Medicare news

Health Care Reform Updates and notifications
 
 
©2005-2017 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use