Working with Anthem Subject Specific Webinar Series

Transcription

1 Working with Anthem Subject Specific Webinar Series E-Tools for Providers Access audio conference: Conference code: # Please Mute Your Phone Use the mute button or press *6 This presentation contains proprietary information of Anthem Blue Cross and Blue Shield. It is intended for Anthem providers. Any redistribution or other use is strictly forbidden. Revision date

2 E-Tools for Providers Agenda Housekeeping and announcements EDI Transactions Public Provider Websites Commercial Medicare Advantage Medicaid Secure Provider Websites Anthem Provider Portal (MyAnthem Provider TM ) Anthem Medicaid Provider Self Service Anthem Medicare Advantage Provider Self Service AIM Specialty Health Revision date

3 E-Tools for Providers Agenda OrthoNet LLC Interactive Care Reviewer (ICR) Availity Web Portal Questions and answers Learn more Feedback survey Revision date

4 Working with Anthem Subject Specific Webinar Series Navigation Entry Page 1. Chose an audio option 2. I Will Call In displays call in telephone numbers 3. You are able to send questions to panelists (presenters) Revision date

5 Working with Anthem Subject Specific Webinar Series Navigation Screen Tools 1. Panel zoom in 2. Panel zoom out 3. Fit to viewer 4. Full screen 1. Panelist (presenter) can send links to presentations to Attendees through Chat. 2. Attendees can chat with panelist (presenter) Revision date

6 EDI Transactions Electronic Data Interchange (EDI) HIPAA complaint transactions 270/271 Eligibility Verification 275/276 Claim Status (batch and real-time) 837P and 837I Claim Submission Supports new claims Secondary (COB) claims Corrected claims 835 Remittance Advice (ERA) Electronic Funds Transfer (EFT) Enroll for EFT and EFT+ERA via CAQH Solutions EnrollHub TM Revision date

7 EDI Transactions Electronic Data Interchange (EDI) continued Why submit claims electronically? Accuracy Time Money Source: CAQH 2016 Index Report: Revision date

8 EDI Transactions Electronic Data Interchange (EDI) continued Electronic Claim Payments What s in it for you? Payments through Electronic Funds Transfer (EFT) accelerates availability of funds. 835 Electronic Remittance Advice (ERA) is an industry consistent data format that may be integrated for auto posting with practice management systems saving time and eliminating human error. Paper Remittance Advice Suppression eliminates the need storage and archiving paper documents. These three elements combined can significantly increase back office efficiency for providers, regardless of practice size. Link: Anthem EFT ERA Brochure Revision date

9 EDI Transactions Electronic Data Interchange (EDI) continued EDI Support Companion Guides under the Documents menu Latest News Broadcast Messages, letters to trading partners and more under the Communications menu Implementation and Testing Support under the Services menu ERA only online registration and the ability to manage the suppression of paper remittance advice under the Register menu EDI Help Desk EDI Solutions at (800) E-Solutions EDI Solutions Team Live Chat Revision date

10 Public Provider Websites Public Website Select Menu at the top of the page and select Providers under Partners in Health in the Support column Revision date

11 Public Provider Websites - Commercial Public Website Select Wisconsin from the drop down box and press Enter Revision date

12 Public Provider Websites - Commercial Provider Home page Horizontal Menu Bar Touts Hyperlinks to more information Revision date

13 Public Provider Websites - Commercial Provider Home page Touts Availity Web Portal Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements Find a Doctor Revision date

14 Public Provider Websites - Commercial Provider Home page Touts - Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements Policies are searchable by term and code Access link to other Blue Plan policies and requirements by entering the member s three-digit alpha prefix Revision date

15 Public Provider Websites - Commercial Provider Home page Touts Find a Doctor Online Directories Find a doctor Search Revision date

16 Public Provider Websites - Commercial Provider Home page Horizontal Menu Provider Home Health and Wellness Plans & Benefits Answers@Anthem Communications Join Our Network Revision date

17 Public Provider Websites - Commercial Provider Home page Hyperlinks Announcements Self-Service and Support Our Plans and Benefits Medicaid Medicare Advantage Plans & Benefits (Commercial) Health and Wellness Communications and Updates Revision date

18 Public Provider Websites - Commercial Provider Home page Too much to remember? Google Search Site Navigation Sheet Link: Anthem Website Navigation Sheet Revision date

19 Public Provider Websites Medicare Advantage Provider Website Select Medicare Solutions Choose Medicare Advantage under Plans and Benefits from the Provider Home Page Revision date

20 Public Provider Websites Medicare Advantage Provider Website Important Medicare Advantage Updates Anthem Blue Cross and Blue Shield Plans and Benefits Medicare Advantage Provider Guides Member ID Card Samples Provider Forms Provider Training and FAQs Clinician Tools and Resources Medicare Advantage Reimbursement Policies Clinical Practice Guidelines ICD-10 Updates Webpage Quality Improvement Program Contact Us Revision date

21 Public Provider Websites Medicaid Provider Website Choose Medicaid under Plans and Benefits from the Provider Home Page Revision date

22 Public Provider Websites Medicaid Provider Website Home Page News and Announcements Useful Publications Vertical Menu Claims Precertification Medical Provider Education Find a Doctor Other Services Revision date

23 Public Provider Websites Medicaid Provider Website Vertical Menu Claims Claim Forms Reimbursement Policies Revision date

24 Public Provider Websites Medicaid Provider Website Vertical Menu Precertification Precertification via the Interactive Care Reviewer (ICR) Link: April Network Update Newsletter (see article beginning on page 24) Revision date

25 Public Provider Websites Medicaid Provider Website Vertical Menu Medical Forms Disease Management Centralized Care Unit Behavioral Health Clinical Practice Guidelines Revision date

26 Public Provider Websites Medicaid Provider Website Vertical Menu Provider Education Manuals, Directories, Training & More Communications & Updates Revision date

27 Public Provider Websites Medicaid Provider Website Vertical Menu Find a Doctor Other Services Dental Vision Revision date

28 Secure Provider Websites Access via the Availity Web Portal Payer Spaces, Anthem Resources tab Choose Provider Portal (Anthem), Medicaid Provider Self Service or Medicare Advantage Self Service (Anthem) MyAnthem provider portal will be retired December 8, 2017 Revision date

29 Secure Provider Websites MyAnthem Provider Reimbursement Policies Currently under Administrative Support menu Access via Availity in after December 8, 2017 Moved to Payer Spaces on Availity Provider Remittance Advice copies Fee Schedule Inquiry Moving December, 2017 Revision date

30 Secure Provider Websites Moving December, 2017 MyAnthem Provider Policies (reimbursement) Professional Facility Revision date

31 Secure Provider Websites Anthem Medicaid Provider Self Service Claims* Precertification Eligibility* Medical Provider Education Reports Member Information Find a Doctor Other Services * Most functionality for claims and member eligibility is available exclusively through the Availity Web Portal. Revision date

32 Secure Provider Websites Anthem Medicare Advantage Provider Self Service Claims* Precertification Patient Information Provider Education * Functionality for claims and member eligibility is available exclusively through the Availity Web Portal. Revision date

33 Secure Provider Websites AIM Specialty Health (AIM) Who is AIM? Anthem, Inc. subsidiary Experienced in the management of radiology, cardiology, oncology, sleep medicine and specialty pharmacy benefits. Mission Improve the clinical appropriateness, safety and affordability of healthcare services. Revision date

34 Secure Provider Websites AIM Specialty Health (AIM) The services Diagnostic Imaging and Cardiology Genetic Testing Musculoskeletal Effective Radiation Therapy Sleep Therapy/Treatment Specialty Pharmacy The members Local and national commercial plans Some self-funded plans Anthem Medicaid (BadgerCare Plus) Anthem Medicare Advantage Copyright 2013 AIM Specialty Health, All Rights Reserved Links: April 2017 Network Update Newsletter August 2017 Network Update Newsletter October Working with Anthem Special Session Musculoskeletal program Quick Reference Guide to AIM Specialty Health Revision date

35 Secure Provider Websites AIM Specialty Health (AIM) Under Auths and Referrals Once you click I Agree, the system will open a new tab and log you seamlessly into the AIM Specialty Health precert site. Tip: Be sure you have allowed Pop-Ups within your Internet browser. Many functionalities within Availity operate by opening a separate screen. Revision date

36 Secure Provider Websites AIM Specialty Health (AIM) Tutorials PROVIDER PORTAL DETAILED INTERACTIVE PROGRAM TUTORIAL Select "Register Now" to launch the registration wizard FOR MORE INFORMATION Visit CUSTOMER SERVICE (800) (7:00 am - 8:00 pm CST M-F) What you need to register: Your address The Tax ID Number for the providers whose regimens you will be entering Your phone and fax number Copyright 2013 AIM Specialty Health, All Rights Reserved Revision date

37 Secure Provider Websites AIM Specialty Health (AIM) Solution Microsites Resources: Program Overview Frequently Asked Questions Access to ProviderPortal sm Order Request Checklists Clinical Guidelines CPT Codes Copyright 2013 AIM Specialty Health, All Rights Reserved Revision date

38 Secure Provider Websites AIM Specialty Health (AIM) Solution Microsites Radiology: Cardiology: Specialty Pharmacy: Sleep: Medical Oncology: Radiation Oncology: Genetic Testing: Musculoskeletal: Copyright 2013 AIM Specialty Health, All Rights Reserved Revision date

39 Secure Provider Websites Physical and Occupational Therapy Utilization Management through OrthoNet Effective November 1, 2015, Anthem implemented a physical therapy and occupational therapy benefit management program for outpatient and office service. The program is administered by OrthoNet LLC. Who is OrthoNet LLC? OrthoNet is a leading musculoskeletal management company located in White Plains, NY. It is a provider-based company with ties to leading practitioners in the Anthem service areas. OrthoNet has significant experience in promoting best practices and evidence-based health care. It works with physical and occupational therapists as well as other providers of therapy services and their patients. Revision date

40 Secure Provider Websites OrthoNet The members Local fully insured commercial o Blue Preferred (HMO); Blue Access SM (PPO); Blue Preferred Plus (POS); Blue Priority; Blue Traditional o ACA compliant plans on or off the Exchange Individual - Anthem Bronze/Silver/Gold/Catastrophic) Blue Priority X WI (on Exchange) and Blue Priority WI (Off Exchange) Small Group - Anthem (Bronze/Silver/Gold/Catastrophic) Blue Priority WI, Blue Preferred, Blue Access( Off Exchange o Administrative Services Only (ASO) Groups may add this program upon renewal The services Physical and Occupational therapy OrthoNet also performs Utilization Management for Anthem Medicaid and individual Anthem Medicare Advantage members. Revision date

41 Secure Provider Websites OrthoNet website Select Provider Under Health Plan Contracts o Choose For Blue Cross and Blue Shield plans click here 41 Revision date

42 Secure Provider Websites OrthoNet website Choose type of coverage Commercial Choose commercial state the member is insured in Wisconsin 42 Revision date

43 Secure Provider Websites OrthoNet website Frequently Asked Questions Forms o Anthem BlueCross BlueShield Therapy Request Form o PT/OT Initial Evaluation Report o PT/OT Initial Evaluation for Vestibular Dysfunction o Functional Progress Chart Online submission and status 43 Revision date

44 Secure Provider Websites OrthoNet website Online submission and status for commercial members On the Anthem BlueCross BlueShield-Wisconsin page select o Prior Authorization Submission and Status section, click on the second click here link for the Account Request Form. Revision date

45 Secure Provider Websites OrthoNet website Online submission and status for commercial members Account Request Form o Complete all fields on the form. The Anthem Provider ID number is internally assigned Anthem ID that appears on provider remittance advice. It is not a required field. o Click on Submit Form to send it to the OrthoNet Web Authorization/User Management Team for processing. o OrthoNet will verify the information and send a link to set up an account password. 45 Revision date

46 Secure Provider Websites OrthoNet website Online submission and status for commercial members - Authorizations o If you submit for multiple locations, you can contact OrthoNet s Web Dept. at (800) to have them add additional locations o You can submit prior authorization requests and attach clinical information. o You can check status of submissions with this tool and OrthoNet will continue fax letters following authorization determination. Link: OrthoNet Web Portal User Guide 46 Revision date

47 Interactive Care Reviewer (ICR) Currently available for Inpatient, Outpatient and Behavioral Health precertification requests for services not medically managed by AIM Specialty Health Immediate Authorization Decision via ICR For local commercial, Anthem Medicaid and Medicare Advantage members* Link to Electronic Provider Access (EPA) for inpatient precertification for BlueCard Program members Accessed through Availity o Register for ICR training from the Precertification Page Watch for 2018 training *Note: ICR is not currently available for Federal Employee Program (FEP), BlueCard, and some National Account members; requests involving transplant services; or services administered by AIM Specialty Health or OrthoNet. For these requests, follow the same precertification process that you use today. Revision date

48 Interactive Care Reviewer (ICR) ICR Features Revision date

49 Interactive Care Reviewer (ICR) Access ICR on the Availity Web Portal To access ICR from the Availity Web Portal: Choose Authorizations & Referrals under the Patient Registration link on the top navigational bar. Revision date

50 Interactive Care Reviewer (ICR) To access ICR from the Availity Web Portal choose Authorizations under the Auths and Referrals As part of the Electronic Provider Access (EPA) mandate, providers will need to enter the member alpha prefix and the service dates. Routing will be based on the prefix entered. Users will be prompted to add Tax ID and NPI for an out of area provider. Availity is an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers with a single secure sign-on. Revision date

51 Interactive Care Reviewer (ICR) Do you want to verify if precert is needed for a member? ICR gives you quick access to that information in most cases. Enter: Patient Information Diagnosis and Procedure Information Provider Details A message returns indicating whether or not a precert is required for most requests. This information can be printed off or saved to a pdf and is available later via an ICR search. If the service is medically managed by AIM or OrthoNet a message directing the user to them will be displayed Revision date

52 Interactive Care Reviewer (ICR) Ordering and servicing physicians and facilities can make an inquiry to view the details for the services using the Authorization / Referral Inquiry option. The first search option is Search by Member. Enter data in required fields. Revision date

53 Availity Web Portal Online real-time request and response in a consistent format for multiple payers with a single sign-on Eligibility, benefits, claim status inquiry and more for any Blue, Federal Employee Program (FEP), Anthem Medicaid or Medicare Advantage member. No cost to providers Availity Learning Center Log on and select Get Trained under the Help menu Availity is an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on Revision date

54 Availity Web Portal Patient Registration Eligibility and Benefits o Add Multiple Patients (up to 50 for the same payer) Authorizations & Referrals o Select Authorizations with Anthem as the payer to access the ICR o Link out to AIM Specialty Health Availity is an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on Revision date

55 Availity Web Portal Claims Claim Status Inquiry Professional and Facility Claim Submission Secure Messaging Save time by starting with an eligibility and benefits inquiry. From the result, go to another option like Claims Claim Status Inquiry. The information about the subscriber/ patient carries over from response to the new inquiry. Availity is an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on Revision date

56 Availity Web Portal Availity Help Online Search Knowledge Client Services Availity ( ) o HIPAA-related errors that you re unable to resolve o Problems with links or other technical problems with Availity Your organization s Availity Access Administrator o Security and Access Anthem EDI Solutions o Report issues with Anthem data returned Your Name Your address Your User Name Availity is an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on Revision date

57 Availity Web Portal Payer Spaces To access the Payer Spaces page, select Payer Spaces, located on the right side of the Availity Web Portal s top menu bar. Choose Anthem Blue Cross Blue Shield from the Payer Spaces drop down menu. Availity is an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on Revision date

58 Availity Web Portal Payer Spaces Anthem functionality applications Clear Claim Connection Education and Reference Center Fee Schedule Remittance Inquiry Revision date

59 Availity Web Portal Payer Spaces Application features Clear Claim Connection o Enter the line of business (commercial, Medicaid, or Medicare Advantage) o Enter gender, date of birth, member and provider state, diagnosis, date and place of service, and procedure codes o Review recommendations and rationale for codes disallowed On the WI Provider Education page: Clear Claim Connection Directions Revision date

60 Availity Web Portal Payer Spaces Application features Clear Claim Connection Select Organization and Tax ID and Line of business from drop down menus. Accept terms and conditions Revision date

61 Availity Web Portal Payer Spaces Application features Clear Claim Connection Complete all fields and be sure to indicate the appropriate diagnosis code version Select Review Claim Audit Results Revision date

62 Availity Web Portal Payer Spaces Application features Clear Claim Connection If the Recommend field indicates Disallow select the hyperlink Disallow for more information on the rationale Revision date

63 Availity Web Portal Payer Spaces Application features Clear Claim Connection View the results which provide detail on the recommendation. Revision date

64 Availity Web Portal Payer Spaces Application features Education and Reference Center o Administrative Support o Clinical Resources o Communication and Education Revision date

65 Availity Web Portal Payer Spaces Application features Fee Schedule o Access to Provider Fee Schedule granted by the Availity Access Administrator for your organization o Access to the professional fee schedule amounts tied to your organization(s) and Tax ID Number(s) o Maximum of 50 codes per inquiry o Modifiers accepted o Dates of service from current date up to 90 days in the future Revision date

66 Availity Web Portal Payer Spaces Application features Fee Schedule Select Organization and Tax ID from drop down menus. Select an option from the Network drop down menu. Revision date

67 Availity Web Portal Payer Spaces Application features Fee Schedule Type Date of Service Select Place of Service from the drop down menu. Type Procedure Codes in the fields Select Add Procedure to open 5 more fields. Ability to request up to 50 procedure codes. Read the Disclaimer at the bottom of the page. Revision date

68 Availity Web Portal Payer Spaces Application features Fee Schedule Select Print to print or save as PDF Pricing results Revision date

69 Availity Web Portal Payer Spaces Application features Remittance Inquiry o Access to view online remittances is associated with the roles of Claims or Claim Status o Remit images available for most Anthem Inc. members o Remits available will include Medicare Crossover claims if the member s home plan is part of Anthem o Images can be saved to the user s PC or printed o View past remittances back 15 months Revision date

70 Availity Web Portal Payer Spaces Application features Remittance Inquiry Remittance Viewer is NOT Anthem s Remittance Inquiry application Go to Payer Spaces Revision date

71 Availity Web Portal Payer Spaces Application features Remittance Inquiry o Search by check or EFT number NPI not required Match is required for Tax ID and Check/EFT number Will not support zero pay remits where the check number is all 9 s or all 0 s. Error message remit not found by data entered. Revision date

72 Availity Web Portal Payer Spaces Application features Remittance Inquiry o Search date range without check or EFT number NPI is required for Issue Date Range search Will support zero pay remits where the check number is all 9 s or all 0 s Search range is limited to 7 days Revision date

73 Availity Web Portal Payer Spaces Application features Remittance Inquiry o Search results Remittance Inquiry Results sort options include: Provider Name Issue Date Check/EFT Number Check/EFT Amount. Select the View Remittance link to access the imaged version of the paper remit. Revision date

74 Availity Web Portal Payer Spaces Resources page 1 AIM Specialty Health Anthem - Wisconsin Provider Home Anthem Enrollment Process (ERA only) CAQH Enrollment Tool ERT/ERA (both) or EFT (only) Interactive Care Reviewer (Pre-Authorization Portal) Overview Medicaid Provider Self Service Medical Policies and Clinical UM Guidelines (for BlueCard Out-of-Area members) Medicare Advantage Provider Self Service (Anthem) Online Provider Maintenance Form Online Provider Maintenance Form Instructions Revision date

75 Availity Web Portal Payer Spaces Resources page 2 Pre-Certification/Pre-Authorization Requirements (for BlueCard Out-of-Area members) Provider Online Reporting Provider Online Reporting Overview Provider Portal (Anthem) Remittance Inquiry Reference Guide Secure Messaging Wisconsin Provider Adjustment Form Instruction Sheet Wisconsin Provider Adjustment Form-DOC file Wisconsin Provider Adjustment Form-PDF file Revision date

76 Learn more Wisconsin (commercial) public provider website home page Provider Education page o Working with Anthem Precertification Tips & Tools Contact Us page (Ready Reference Guide) Anthem WI Medicare Advantage public provider website Anthem WI Medicaid public provider website Availity Web Portal Stay connected Sign up for Network eupdate s at this link: Revision date

77 E-Tools for Providers Questions? 77

78 Working with Anthem Subject Specific Webinar Series Please complete our feedback survey Individuals completing the survey within 2 business days will be eligible for a Blue Prize package Winner chosen at random will be notified via on the 3 rd business day 78

79 Thank you for attending! Anthem Blue Cross and Blue Shield is the trade name of 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.