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Anthem Blue Cross and Blue Shield 2 nd Quarter Updates for Hoosier Healthwise and Healthy Indiana Plan MAY/JUNE 2013 Serving Hoosier Healthwise and Healthy Indiana Plan

2 Quarter Updates for Hoosier Healthwise and Healthy ... · 2nd Quarter Updates for Hoosier Healthwise and Healthy Indiana Plan MAY/JUNE 2013 Serving Hoosier Healthwise and Healthy

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Page 1: 2 Quarter Updates for Hoosier Healthwise and Healthy ... · 2nd Quarter Updates for Hoosier Healthwise and Healthy Indiana Plan MAY/JUNE 2013 Serving Hoosier Healthwise and Healthy

Anthem Blue Cross and Blue Shield2nd Quarter Updates for Hoosier Healthwise and Healthy Indiana Plan

MAY/JUNE 2013Serving Hoosier Healthwise and Healthy Indiana Plan

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Agenda ForAgenda For Presentation

•MEMBER RESPONSIBILITIES

•VISIT RESPONSIBILITIES

•PROVIDER RESPONSIBILITIES

•OPERATIONAL RESPONSIBILITIES

•CLAIM SUBMISSIONS

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Member Responsibilities

22

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Member Responsibilities:

M b h i ht d ibiliti h lth

Member Responsibilities:Rights and Responsibilities

Members have rights and responsibilities as health care consumers, as protected under 42 CFR 438.100.

▪ Anthem communicates these rights and responsibilities to our members▪ Anthem communicates these rights and responsibilities to our members through welcome packets, including the Evidence of Coverage.

▪ Anthem communicates these to providers through the Provider OperationsAnthem communicates these to providers through the Provider Operations Manual. We also post these on our website at www.anthem.com.

▪ Anthem recommends reviewing these guidelines as part of your continuing g g p y gassessment of office policies and procedures.

*Provider Operations Manual, Chapter 21

33

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Member Responsibilities:Member Responsibilities:Member Assignment

The Division of Family Resources (DFR) determines when an applicant is approved for eligibility in Hoosier Healthwise or HIP.pp g y

▪ Member enrollment is effective on the first or 15th calendar day of a month.

▪ Newborns will be assigned to the mother’s MCE on the date of delivery.

* IHCP Manual Chapter 2

44

p

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Member Responsibilities:

Upon approval:

pMember Assignment

Upon approval:▪ Member has 14 days to select a Managed Care Entity (MCE). ▪ After 14 days, an MCE is selected for the member (known as auto-

assignment) based on the member’s prior participation or family memberassignment) based on the member s prior participation or family member assignment.

▪ The Enrollment Broker is responsible for assisting members with a selection of an MCE.

*The member then begins a 90-day free change period when they may change from one MCE to another for any reason. When the period ends, the

b i ith th h MCE f 9 th d t tmember remains with the chosen MCE for 9 months and may not move to another MCE except for reasons that meet the standard of just cause.

55

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Member Responsibilities:Member Responsibilities:Member Assignment

Primary Medical Provider Assignments:

• MCE’s are responsible for making Primary Medical Provider (PMP) assignments p g y ( ) gwithin 30 days of enrollment.

• Each HIP and HHW member receive an Anthem welcome letter and packet within 5 calendar days of enrollment.

• Anthem will attempt 3 phone calls on 3 different days to assist the member in choosing a PMP.

• A reminder postcard in sent out on the 15th day of the month to encourage a PMP selectionPMP selection.

66

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Member Responsibilities:

Members who do not make a PMP selection will be auto-assigned to

Member Responsibilities:Member Assignment

Members who do not make a PMP selection will be auto-assigned to physician through an automated assignment process.

• Members are assigned a PMP within 30 miles of their residence.• Anthem will consider previous relationships with the provider.Anthem will consider previous relationships with the provider.

PMP Transfer:PMP Transfer:▪ We strongly encourage members to select a PMP and remain with that

provider. ▪ Members may change a PMP at any time, for any reason. Members may y g y y y

call our Customer Care Center at 1-866-408-6132 to choose another PMP.

77

*Provider Operations Manual, Chapter 11, page 134.

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Visit Responsibilities

88

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Visit Responsibilities:Visit Responsibilities:Member Eligibility

Member Eligibility:• Anthem updates member eligibility in our systems following notification by

FSSAFSSA.• Because eligibility can change, providers must verify the member’s eligibility at

each visit — before providing services to members.• To prevent fraud and abuse, providers should confirm the identity of the person p , p y p

presenting the health care card. Claims submitted for services rendered to non-eligible members will not be eligible for payment.

• HHW members have state issued identification cards. HIP members have A h id ifi i dAnthem identification cards.

99

*Provider Operation Manual Chapter 5, page 40.

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Visit Responsibilities:

V if M b Eli ibilit

pMember Eligibility

Verify Member Eligibility:▪ Log in to the Indiana’s secure website Web interChange at

https://interchange.indianamedicaid.com/Administrative/logon.aspxIf PMP i li t d ll A th t 1 866 408 6132 i it M A th▪ If no PMP is listed, call Anthem at 1-866-408-6132 or visit MyAnthem to verify PMP assignment.

▪ St. Francis Health Network (SFHN) Members V if li ibilit i W b i t Ch• Verify eligibility using Web interChange.

• Under Managed Care Network it will indicate “Anthem St. Francis Network”

• If no PMP is listed call Anthem at 1 866 408 6132 to verify PMP• If no PMP is listed, call Anthem at 1-866-408-6132 to verify PMP assignment.

▪ Do not use MyAnthem to verify member eligibility.

1010

*Provider Operation Manual Chapter 10, page 40

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Visit Responsibilities:

P i M di l P id (PMP)

pManaged Care Model

Primary Medical Provider (PMP)

▪ Manages all care to members on their panel.

▪ PMP must provide a referral for all services. (Exemptions: slides 13 & 14.)PMP must provide a referral for all services. (Exemptions: slides 13 & 14.)

▪ If a specialist determines a need to refer a member for additional services (DME, Home Health, etc.), the specialist must coordinate with the member’s PMP. The PMP would then make the referral.PMP. The PMP would then make the referral.

▪ Hospitals must work with their ancillary providers to ensure they are receiving referral from the member’s PMP.

*Anthem Provider Bulletin, December 9, 2011

1111

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Visit Responsibilities:

Exceptions to this policy include:

pManaged Care Model

Exceptions to this policy include:

No PMP identified for the member

If one physician is on call or covering for another. In this case, the billing p y g , gprovider must complete Box 17b of the CMS-1500 claim form to receive reimbursement.

If the provider is in the same provider group, or has the same tax ID or NPI as p p g p,the referring physician, and is an approved provider type

If the billing or referring physician is any of the following: A Federally Qualified Health Center, an Indian Health Provider, or an Urgent Care Center, , g

Services that were provided after hours

Emergency services (services performed in place of service 23)

1212

*Anthem Provider Bulletin, December 9, 2011

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Visit Responsibilities:pManaged Care Model

Exceptions (continued)

Family Planning services

Diagnostic specialties such as lab and x ray services Diagnostic specialties such as lab and x-ray services

Anesthesia claims

Professional inpatient claims

OB/GYN claims

Self-referrals

*A th P id B ll ti D b 9 2011

1313

*Anthem Provider Bulletin, December 9, 2011

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Provider ResponsibilitiesProvider Responsibilities

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Provider Responsibilities:

D t ti i d

Documentation

Documentation required: ▪ Consents: The provider should obtain required signed consent before

providing care. ▪ Referrals: Copies of reports with documentation the provider has▪ Referrals: Copies of reports with documentation the provider has

reviewed and discussed with member. If the member failed to follow-up, note this is the record with documentation of discussion with the member.

▪ Health care screenings: Copies of the results with documentation the provider has reviewed and discussed with member. If the member failed to follow-up, note this is the record with documentation of discussion with the memberdiscussion with the member.

▪ Immunizations: including immunizations given outside of your office.▪ Health education, counseling and anticipatory guidance. ▪ Assessment of risk factors such as smoking alcohol and drugs: Include

1515

▪ Assessment of risk factors such as smoking, alcohol and drugs: Include documentation of referrals.

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Provider Responsibilities:

Documentation required continued:

pDocumentation

Documentation required continued:▪ Phone messages ▪ Missed appointments with documentation of follow-up▪ Problem list that contains documentation of chronic problemsProblem list that contains documentation of chronic problems▪ Medication list with documentation of chronic and acute medications▪ Clear documentation of allergies ▪ Nutrition assessment for children and adultsNutrition assessment for children and adults▪ Developmental assessment for children▪ Vision and Hearing assessment for children▪ Dental assessment and referral▪ Dental assessment and referral

*Documentation shall reflect the necessary criteria to be considered valid toward HEDIS measurement. (See HEDIS Measures handout)

1616

*Provider Operations Manual Chapter 7, Pages 59-60 and chapter 18, pages 180-184

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Provider Responsibilities: pEPSDT

Anthem provides well child visits for HHW members from ages 0-21 years and HIP members ages 19 and 20, following federally mandated Early and Periodic Screening, Diagnostic and Treatment Services (EPSDT) program guidelines.

EPSDT Screening Requirements:▪ Comprehensive health and developmental history, including both physical and

mental health developmentp▪ A comprehensive unclothed physical exam, which includes pelvic exams and

Pap test for sexually active females▪ Appropriate immunizations according to age and health history▪ Laboratory tests, including blood lead

*P id O ti M l Ch t 4 59 60

1717

*Provider Operations Manual, Chapter 4, pages 59-60

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Provider Responsibilities:

EPSDT S i R i t ti d

pEPSDT

EPSDT Screening Requirements continued:

▪ Health education, including anticipatory guidance; an evaluation of age appropriate risk factorsappropriate risk factors

▪ Nutritional assessment▪ Sensory screening (vision and hearing) for Hoosier Healthwise members only▪ Dental assessment for Hoosier Healthwise members only▪ Dental assessment for Hoosier Healthwise members only▪ Tuberculosis screening▪ Documented and current immunizations

Anthem encourages providers to utilize the resources of the Bright Futures program http://brightfutures.aap.org

1818

*Provider Operations Manual, Chapter 4, pages 59-60

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Provider Responsibilities:

Notification of Pregnancy

pNotification of Pregnancy

Notification of Pregnancy

▪ The Notification of Pregnancy (NOP) form has been developed to pinpoint risk factors in the earliest stages of pregnancy for women enrolled in Hoosier Healthwise and participating in the Presumptive Eligibility programHealthwise and participating in the Presumptive Eligibility program.

Importance of Notification of Pregnancy

▪ Help ensure better birth outcomes

▪ Identify risk factors and high-risk pregnancies

▪ Coordinate case management

▪ Obtain referrals

▪ Reduce the number of early deliveries

Red ce the n mber of pregnant omen ho smoke

1919

▪ Reduce the number of pregnant women who smoke

*Provider Operations Manual, chapter 7, page 65

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Provider Responsibilities:

BILLING GUIDELINES CPT CODES/MODIFIER COMBINATION

pNotification of Pregnancy

BILLING GUIDELINES: CPT CODES/MODIFIER COMBINATION▪ 99354TH▪ Reimbursement is $60

O b▪ One per member, per pregnancy▪ Only permitted on successfully submitted, complete and timely NOPs

• Submit via Web interChangeP i 29 k l• Pregnancy is 29 weeks or less

• Entered in Web interChange within 5 calendar days of date of service

2020

Note: Provider or provider designee should complete the NOP form. NOP is not covered for HIP members.

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Provider Responsibilities:pReferrals to outside agencies

Women, Infant and Children (WIC):▪ Providers should refer pregnant women and young children to the local

WIC program.Community agencies:

▪ Providers should ensure that office personnel have specific knowledge of local reporting requirements, agencies, and procedures to make telephone and written reports of known or suspected cases of child and elder abuseand written reports of known or suspected cases of child and elder abuse.

Disease reporting:▪ Providers should follow state disease reporting requirements.

2121

*Provider Operations Manual, chapter 4, pages 38-39

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Provider Responsibilities:

T b C ti G id li

pReferrals to outside agencies

Tobacco Cessation Guidelines▪ Assess tobacco use and/or exposure to second hand smoke. ▪ Offer quick advice about quitting.

D t th t d i d f l i th d• Document the assessment, advice and referral in the record.• *Note this is a billable service.

▪ Offer members resources to stop smoking, including the Indiana Tobacco Quitline: 1 800 QUITNOW (1 800 784 8669)Quitline: 1-800-QUITNOW (1-800-784-8669)

▪ For pregnant women, use the state’s online Notification of Pregnancy (NOP) form.

▪ Random member surveys are conducted to inquire if providers are discussingRandom member surveys are conducted to inquire if providers are discussing smoking habits or exposure to second hand smoke.

*IHCP Banner Page 201217

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IHCP Banner Page 201217*Provider Operations Manual, chapter 7, pages 69-70

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Provider Responsibilities:pPrior Authorization

Participating providers:▪ Authorization is NOT required when referring a member to an in network

specialist.Authorization IS required when referring a member to an out of network▪ Authorization IS required when referring a member to an out-of-network provider.

▪ Check the Prior Authorization list regularly for any updates on services that require Prior Authorization.

Nonparticipating providers:▪ ALL services require Prior Authorization.

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Provider Responsibilities:

H t bt i P i A th i ti

pPrior Authorization

How to obtain Prior Authorization:Hoosier Healthwise▪ Call Utilization Management department at 1-866-408-7187.

O f th U i l PA f t 1 866 406 2803▪ Or, fax the Universal PA form to 1-866-406-2803.

Healthy Indiana Plan (HIP)C ll Utili ti M t d t t t 1 866 398 1922▪ Call Utilization Management department at 1-866-398-1922.

▪ Or, fax the Universal PA form to 1-866-406-2803.

Universal PA Form and Resource Tools available online:Universal PA Form and Resource Tools available online:▪ www.anthem.com▪ProvidersProviders Spotlight State Sponsored Plans-Indiana Hoosier Healthwise and Healthy Indiana PlanPrior Authorization and Preservice Review

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Review

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Provider Responsibilities:

Wh t t h d h lli /f i Utili ti M t

pPrior Authorization

What to have ready when calling/faxing Utilization Management:▪ Member name and ID number▪ Diagnosis with ICD9 code

P d ith CPT d▪ Procedure with CPT code▪ Date(s) of Service▪ Primary Physician, Specialist, and Facility performing services

Cli i l i f ti t t th t▪ Clinical information to support the request▪ Treatment and discharge plans (if known)

Time Frames:N t i l t d ithi 7 l d d f d t f t▪ Non-urgent reviews are completed within 7 calendar days from date of request.

▪ Urgent reviews are completed within 72 hours from the date of the request.▪ Emergency services do not require prior authorization.

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Provider Responsibilities:pEmergency Room

Emergency Room Program, Member Intervention ▪ Outreach phone calls

• Members are called if they have visited the ER at least 2 times in the past 180 d f di i th t ld h b t t d t id f th ER180 days for a diagnosis that could have been treated outside of the ER.

• Members receive an Interactive Voice Response (IVR) call to identify why they used the ER instead of visiting their doctor.

▪ Educational materials• Members then receive a mailing customized to the responses during the

IVR callIVR call.

▪ Case management (if appropriate)

2626

*Provider Operations Manual, chapter 7, page 68

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Provider Responsibility:

Emergency Room Program Provider Assistance

Provider Responsibility: Emergency Room

Emergency Room Program, Provider Assistance▪ Provider strategies:

• Discuss provider expectations regarding ER use with members.• Develop a system to receive ER reports from the hospitals• Develop a system to receive ER reports from the hospitals.

- Follow-up on reports. - Schedule appointments as warranted.

• Utilize the Anthem Outreach Request Form• Utilize the Anthem Outreach Request Form• Refer member to Anthem’s 24/7 NurseLine, 1-866-800-8780

▪ Anthem sends My Health Advantage reports to the member’s PMPs regarding the ER visit Providers are encouraged to follow-up with members regardingthe ER visit. Providers are encouraged to follow-up with members regarding emergency room visit.

▪ Anthem providers ER brochures for providers to educate members on appropriate ER use.

2727

*Provider Operations Manual, chapter 7, pages 68-69

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Provider Responsibilities:

Eff ti J 1 2010 th t t f I di b d i i t i h

Provider Responsibilities:Pharmacy

Effective January 1, 2010, the state of Indiana began administering pharmacy benefits for Hoosier Healthwise and Healthy Indiana Plan. For more information go to www.indianamedicaid.com and select the tab Pharmacy Services.

▪ The Preferred Drug List (PDL) is located on the state’s website at www.indianamedicaid.com and www.indianapbm.com under Pharmacy Services.

• Generic substitution under the program is mandatory.

▪ All prior authorization forms for pharmacy can be found on the state’s website at http://provider.indianamedicaid.com/general-provider-services/providing-services/prior-authorization.aspx.

2828

*IHCP Manual, chapter 9, page 10

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Operational Responsibilities

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Operational Responsibilities:Access to Care

Access to care: General Appointment Scheduling▪ Emergency examinations: triaged and treated immediately on presentation

at the PMP site▪ Urgent examinations (members with persistent symptoms): treated no later

than the end of the following work day after initial contact with the PMP site▪ Non-urgent “sick visits”: within 72 hours▪ Non-urgent routine examinations: within six weeks▪ Preventive health services: within two weeks▪ Initial Health Assessment: 90 calendar days from enrollment date (strongly

d d)recommended)

*P id O ti M l h t 14

3030

*Provider Operations Manual, chapter 14

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Operational Responsibilities:Access to Care

Access to care: Prenatal and Postpartum Visits

▪ 1st trimester within 14 calendar days of request▪ 2nd trimester within 7 calendar days of request▪ 3rd trimester within 3 business days of request▪ High risk pregnancy within 3 business days of identification or immediately

if i tif an emergency exist▪ Postpartum exam within 3 to 8 weeks after delivery

3131

*Provider Operations Manual, chapter 14

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Operational Responsibilities:Access to Care

After-hour Services:

▪ Anthem members have access to quality, comprehensive health care services 24 hours a day, 7 days a week.

▪ Members can call their PMP with a request for medical assessment after PMP normal office hours. Th PMP t h ft h t i l t th t th▪ The PMP must have an after-hours system in place to ensure that the member can reach the physician or an on-call physician with medical concerns or questions.

3232

*Provider Operations Manual, chapter 14

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Operational Responsibilities:Access to Care

After-hour Services continued:

▪ An answering service or after-hours personnel must forward member calls directly to the PMP or on-call physician, or instruct the member that the provider will contact the member within 30 minutes.

▪ The answering service or after-hours personnel must ask the member if the call is an emergency In the event of an emergency they must immediatelycall is an emergency. In the event of an emergency, they must immediately direct the member to hang up and dial 911 or to proceed directly to the nearest hospital emergency room.

3333

*Provider Operations Manual, chapter 14

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Operational Responsibilities: Missed Appointments

Missed Appointment Guidelines

▪ Document and track missed appointments▪ Follow-up by phone or mail▪ Consider appointment reminders▪ Develop “missed appointment” policy and discuss with patients▪ Develop missed appointment policy and discuss with patients ▪ Develop and send “missed appointment” letter

3434

*Provider Operations Manual, chapter 14

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Operational Responsibilities: Provider Panels

PMP HHW and HIP panel assignment:

▪ A list of the PMP’s assigned patients for HHW and HIP can be obtained from MyAnthem on our secure provider website.

▪ Utilize the PMP’s Site Code to set up a secure password. The site code is identified on your Anthem Welcome Letter. C t t P ti C lt t if d i t ith it d▪ Contact your Practice Consultant if you need assistance with your site code.

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Operational Responsibilities:Provider Panels

Monthly Review of panel:

▪ Checking the list monthly can help you identify new patients that are g y p y y passigned to your practice.

▪ Schedule a new patient appointment.▪ Complete an Initial Health Assessment.▪ Assists provider in meeting Pay For Performance component: new

patients seen within the first 90 days of assignment.

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Operational Responsibilities:Provider Panels

H t HHW id lHow to access HHW provider panels:

▪ 1. Go to www.anthem.com2 L i t M A th▪ 2. Log into MyAnthem

▪ 3. Under Online Services, click on Online Provider Inquiry▪ 4. Click on Reports tab

5 Cli k St t S d Eli ibilit R t▪ 5. Click on State Sponsored Eligibility Reports▪ 6. Enter license number and site code.▪ 7. Click submit.

3737

*Site code can be found on the Anthem Welcome Letter or contact your Practice Consultant.

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Operational Responsibilities:Provider Panels

Updating panel information▪ Use Provider Maintenance Form on www.Anthem.com

• Utilize to put panel on hold• Utilize to update panel numbers• Utilize to make changes in demographic information

Link to Provider Maintenance Form▪ https://central.provider.anthem.com/mwpmf/PMFControllerServlet

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Operational Responsibilities:Provider Panels

Disenrollment of a member:▪ A PMP can request a member reassignment to another PMP by submitting

the Provider Request for Member Deletion from PMP Assignment form located online at www anthem comlocated online at www.anthem.com.

▪ Anthem will conduct a thorough upper-level review of the request for reassignment to determine whether the cause and documentation are sufficient to approve a reassignment request. pp g q

▪ The change will be effective 30 days from the date Anthem receives the form. ▪ Upon completing the PMP change, Anthem forwards the form and any other

information related to the case to the customer service representative. This representative informs the member of the change within five working days.

▪ The PMP will still be responsible for the patient until the reassignment is made.

3939

*Provider Operations Manual, chapter 11

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Operational Responsibilities: OB/GYN

OB /GYN providers contracted as PMP’s▪ Contracted to provide all primary care services as a PMP.

If the OB/GYN does not intend to provide primary care services after delivery, the member should be removed from the OB/GYN panel.▪ Members who are pregnant are not reassigned after the member has

delivereddelivered.▪ Encourage member to call Member Services at 1-866-408-6131to request

assignment to a new PMP.▪ Use Provider Request for Member Deletion from PMP Assignment form to▪ Use Provider Request for Member Deletion from PMP Assignment form to

have the member removed from panel.

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Operational Responsibilities:Staff Training

Staff receives periodic training:• Member safety

- Infection Control/Universal PrecautionsBl d b th ti- Blood borne pathogens exposure prevention

- Biohazard waste handling• Member Information and Confidentiality

Requests for medical records- Requests for medical records- Storage and handling of in-house records

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Operational Responsibilities:Staff Training

C lt l S iti it Ti f S f l E t ith Di M bCultural Sensitivity: Tips for Successful Encounters with Diverse Members▪ Styles of Speech▪ Eye Contact▪ Body Language▪ Gently Guide Patient Conversation▪ Build rapport with the patientBuild rapport with the patient▪ Make sure patients know what you do▪ Keep patients’ expectations realistic

Work to build patients’ trust in you▪ Work to build patients trust in you▪ Determine if the patient needs an interpreter or the visit▪ Give patients the information they need

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▪ Make sure patients know what to do

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Operational Responsibilities:Medical Records

M di l dMedical records

▪ Organized and stored in a secure manner E b th i d l l▪ Easy access by authorized personnel only

▪ Retained for a period of 7 years after the last patient encounter.▪ Provide Anthem with prompt access, upon demand, to medical records

or information for quality management or other purposes such asor information for quality management or other purposes such as HEDIS or medical record reviews.

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Claims Process

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Claim Process:Timely Filing

I iti l Cl i S b i iInitial Claim Submission:

▪ 90 calendar days from the date of service for Anthem contracted idproviders

▪ 365 calendar days for non-participating providers▪ Submit the initial claim electronically or mail to:

Attn: ClaimsAnthem Blue Cross and Blue ShieldPO Box 105187Atlanta, GA 30348

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Claim Process:Timely Filing

Disputing a processed claim:▪ 63 calendar days from the date of the Remittance Advice.

S b it th Di t R l ti R t F l ith f th▪ Submit the Dispute Resolution Request Form along with a copy of the EOB, as well as other documentation to help in the review process, to:

Attn: Claims CorrespondenceAttn: Claims CorrespondenceAnthem Blue Cross and Blue ShieldPO Box 6144Indianapolis, IN 46206-6144p ,

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Claim Process:Timely Filing

Appealing the disputed claim decision:▪ 33 calendar days from the date of notice of action letter advising of the

adverse determination.S b i h Di R l i R F l i h l▪ Submit the Dispute Resolution Request Form along with a letter stating that you are appealing. Attach a copy of the Remittance Advice, claim, as well as other documentation to help in the review process. Submit to:

Attn: Complaints – AppealsAnthem Blue Cross and Blue ShieldPO B 6144PO Box 6144Indianapolis, IN 46206-6144

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Claim Process:Timely Filing

P i tiProcessing time:• 21 days for clean electronic claims before resubmitting.• 30 days for clean paper claims before resubmitting.

Ch k l i t t b f b itti If d f l i b it• Check claim status before resubmitting. If no record of claim – resubmit

Note: Be sure to ask the Provider Services Representative to verify if the claim is imaged in Filenet/ WCF if the claim is not showing in our processingclaim is imaged in Filenet/ WCF if the claim is not showing in our processing system.

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*Do not resubmit if the claim is on file in the processing or image system.

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Operational Responsibilities:Provider Operations Manual

Provider Operations Manual ▪ This Manual is a comprehensive document designed to inform network

physicians, hospitals, facilities, ancillary providers and other health care professionals of Anthem guidelines and requirementsprofessionals of Anthem guidelines and requirements.

▪ Providers can learn how to verify member eligibility, submit a timely claim form request authorization for services and much moreform, request authorization for services, and much more.

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Operational Responsibilities:Provider Operations Manual

How to find POM:▪ 1. Go to www.anthem.com▪ 2. Click on Providers in the upper left corner.▪ 3. Select Indiana from the drop down box, click enter▪ 4. Hover over Plans & Benefits, click on State Sponsored Business▪ 5. Click on Indiana Hoosier Healthwise and Indiana Health Indiana Plan▪ 6. Scroll down to Provider Communications▪ 7. Click on Provider Operations Manual and Important Updates

▪ http://www.anthem.com/wps/portal/ahpprovider?content_path=provider/in/f3/s4/t1/pw_b134078.htm&label=Provider%20Operations%20Manual%20and%20Important%20Updates%20for%20Hoosier%20Healthwise%20and%20Healthy%20Indiana%20Plan&state=in&rootLevel=2

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20Healthy%20Indiana%20Plan&state=in&rootLevel=2

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Important Contact InformationImportant Contact Information

P id S iProvider Services

Hoosier Healthwise 1-866-408-6132

HIP 1-800-345-4344800 3 5 3Prior Authorization

1-866-408-7181 HHW(phone)

1-866-398-1922 HIP (phone)

1-866-406-2803 (fax)M b S iMember Services

1-866-408-613124/7 NurseLine

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/ u se e

1-866-800-8780

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Where to find presentation:Where to find presentation:

This presentation has been posted on the Anthem website Provider Resources page, under the heading Health Education:

1. www.anthem.com2. Under OTHER ANTHEM WEBSITES, click on Providers3. Under Providers │Spotlight, click on State Sponsored Plans –

Indiana Hoosier Healthwise and Healthy Indiana PlanIndiana Hoosier Healthwise and Healthy Indiana Plan.4. On the State Sponsored Plan home page, click on Indiana

Hoosier Healthwise and Healthy Indiana Plan (HIP).5 Scroll down to Health Education and click on Webinars and5. Scroll down to Health Education and click on Webinars and

Presentations.

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Thank you for serving our y gAnthem members!

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee 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. ® HEDIS is a registered mark of the National Committee for Quality Assurance (NCQA). INW3724-PP 04/23/2013 Aprimo 797032

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g y ( ) p