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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
Diabetes Prevention Program expansion
Availity to launch new eligibility and benefits functionality
Spring 2015 Provider Webinars – recorded versions now available online
Access online Remittance Advices in ProviderAccess, via the Availity Web Portal
Update to Claims Processing Edits and Professional Reimbursement Policies
Fraud, Waste and Abuse Detection
Pre-Payment Review
Clinical Practice and Preventive Health Guidelines Available Online
Pharmacy information available on anthem.com
Case Management Program
Important information about Utilization Management
Members’ Rights and Responsibilities
Medicare Advantage Updates

Osteoporosis Screening, medication encouraged for women

DMARDs help prevent long-term disability

Encourage Medicare Advantage members to control high blood pressure

ICD-10-CM: Human Immunodeficiency Virus (HIV) status

Health Care Reform Updates (including Health Insurance Exchange)
 
Spring Provider Seminars – still a chance to attend via webinar!
Mountain Enhanced network expands to small group and large group business July 1, 2015
Updated Alpha Prefix Reference
Updated Escalation Contact List
ICD-10 Updates: ICD-10 Pre-authorizations to begin in June for Service Dates October 1, 2015 or after
Medical chart reviews begin July for members with plans on or off the exchange
Inovalon continues outreach efforts on Anthem’s behalf to help identify members needing care
REMINDER: Filing claims for air ambulance services for Blue Cross and Blue Shield patients
Non-participating neuromonitoring services
Update to Claims Processing Edits and Professional Reimbursement Policies
Attention Oncologists, Hematologists and Urologists
Notice of Post-Service Review for Specialty Drugs
Medicare Advantage Updates

Please Follow CMS Guidelines for Medicare Advantage Part B Immunizations Claims Filing

Medicare Advantage pre-certification requirements available on anthem.com

Failure to pre-certify an admission or provide notice of emergent inpatient admission will result in administrative denial effective May 1, 2015

Health Care Reform Updates (including Health Insurance Exchange)
 
Spring Provider Seminars starting next week!
AIM Specialty Health® enhancing web portal experience for Servicing Providers
CAQH ProView™ – now available!
Update your Anthem provider demographic information via the Availity Web Portal
Update to Claims Processing Edits and Professional Reimbursement Policies
Clinical Practice and Preventive Health Guidelines available online
Pharmacy information available on anthem.com
We believe in Continuous Improvement
Coordination of Care
Non-participating lab referrals
Medicare Advantage Updates

Anthem encourages Medicare Advantage members to stay up-to-date on preventive care

CMS weighs monitoring statin use among diabetics

Medicare Advantage Reimbursement Policy changes posted on anthem.com/medicareprovider

Clinical Practice Guidelines assist with chronic Condition Management

ICD-10-CM: Breathe easy with these coding tips for COPD

Health Care Reform Updates (including Health Insurance Exchange)
 
Drug fee schedule update
Reminder: Physician Fee Schedule change to 2014 RBRVS effective July 1, 2015
Spring Provider Seminars coming soon!
ICD-10 Updates: Free Coding Practice Tool, End-to-End Testing Results
Diabetes Prevention Program: Proactively prevent diabetes among your patients
Access co-payment, co-insurance, remaining deductible, and HRA information online via the Availity Web Portal
Update to the Cancer Care Quality Program – Attention Oncologists, Hematologists and Urologists
Quality and Cost Program to expand
Update to Claims Processing Edits and Professional Reimbursement Policies
Improving efficiencies in the Utilization Management process: Include reference numbers on fax cover sheets
Important Reminder for Colorado Providers and Facilities regarding written correspondence
ConditionCare Program Benefits Patients and Physicians
HEDIS® 2015: Colorectal Cancer Screening
Medicare Advantage Updates

ACIP updates pneumococcal vaccine policy

ClaimCheck version 55 upgraded

Precertification required on four new Part B injectables

Health Care Reform Updates (including Health Insurance Exchange)

Integrated Care Model for plans purchased on Connect for Health Colorado benefits patients and physicians

 
Missing 1099 IRS Form?
Updated Alpha Prefix Reference
Updated Escalation Contact List
Access online Remittance Advices in ProviderAccess, via the Availity Web Portal
Federal Employee Program® HEDIS® medical records collection
AIM Specialty Health includes the Federal Employee Program®
Clinical Practice and Preventive Health Guidelines Available on the Web
Pharmacy information available on anthem.com
Update to Claims Processing Edits and Professional Reimbursement Policies
Health Care Reform Updates (including Health Insurance Exchange)

Updated contact information for ERA and EFT registration

Preventive care services covered with no member cost-share (updated February 12, 2015)

Claim adjustments for members reaching out-of-pocket maximums

 
Implementation of the Cancer Care Quality Program Prostate Cancer Treatment Pathways will be delayed until April 1, 2015
UPDATE: Paper remittances no longer being mailed
ICD-10 Updates: Clinical Documentation Improvement
Updated Escalation Contact List
Inovalon requests for 2015
Maternity-Related HEDIS Measures Frequently Asked Questions
FEP® changes call in hours for UM/CM
Update to Claims Processing Edits and Professional Reimbursement Policies
Non-participating lab referrals
HEDIS® 2015: Easy Submission of Commercial HEDIS Medical Records
HEDIS® 2015: Controlling High Blood Pressure Measure
HEDIS® 2014 Results Are In – correction to December 2014 issue
Medicare Advantage Updates

Avoid Second Fills of High- Risk Medications

Provider Requirements and Medicare Notices

ICD-10-CM: ICD-9 vs. ICD-10 for Atrial Fibrillation and Flutter

Medicare Advantage HMO Referral Reminder – PCPs do not need to call Anthem to obtain a referral

Reminder: clinical information required for Medicare Advantage members

Health Care Reform Updates (including Health Insurance Exchange)
 
Drug fee schedule update
Audit vendor partner for Colorado market
Update to Claims Processing Edits and Professional Reimbursement Policies
Reminder: New Mountain Enhanced network effective January 1, 2015
Reminder: Surveys for the 2014 Anthem Quality-In-Sights® Primary Care Incentive Program due no later than January 28, 2015
Pre-Service Medical Review for Specialty Drugs
No cost cultural competency trainings for providers – CME/CEU credits awarded
Creating an LGBT Friendly Practice – online experience available
Clinical Practice and Preventive Health Guidelines available on the web
Pharmacy information available on anthem.com
Medicare Advantage Updates

Flu prevention and treatment saves lives

Routine physical exams are covered in 2015

Individual MA membership has moved to a new claims system

Home Health claims – please split Dates of Service for 2014 and 2015

Please submit no more than one Place of Service per claim

Law excludes some Part D Drugs; Customer Service ready to help with members’ questions

$0 Copay medications available to Medicare Advantage members with chronic conditions

Compounded drugs no longer a covered benefit for individual MAPD and PDP plans

Prior Authorization required for members

New 2015 precertification fax number for Skilled Nursing, Long Term Acute Care and Inpatient Rehab for Medicare Advantage

Health Care Reform Updates (including Health Insurance Exchange)

Access more information about three month grace period status electronically – December 2014

Member ID card update for 2015 ACA-compliant health plans – December 2014

Important update about Anthem’s 2015 ACA-compliant health plans – December 2014

 
 
©2005-2015 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