May 2015 SPECIAL EDITION In this issue Page Announcements May 2015 Network Update addresses transition to AIM Specialty Health ; new incentive opportunity regarding health assessments for members with exchange plans 2 Business update Virginia imaging and sleep management programs 4 AIM online registration for professional and facility providers 5 Radiology and cardiology services administered by AIM Specialty Health FAQs 6 OptiNet registration for sleep disorder management FAQs 12 AIM Specialty Health webinars offered beginning June 9 15 Schedule of AIM webinars June 2015 16 Health care reform update (including health insurance exchange) New incentive opportunity for physicians in Virginia: Receive incentives for each properly completed SOAP Note for identified members with health plans purchased on or off the exchange 17 anthem.com Important phone numbers 1 of 18 VAPENABSNL (05/15)
Announcements May 2015 Network Update addresses transition to AIM Specialty Health ; new incentive opportunity regarding health assessments for members with exchange plans This is a special edition of our Anthem Network Update provider newsletter. As part of our ongoing commitment to provide our network providers with timely communications about upcoming changes within our organization that impact the way you do business with us, Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. are releasing a special edition in May to share some pertinent and late-breaking news. This newsletter edition provides important details about two separate topics regarding our company s efforts to: Transition the management of outpatient advanced diagnostic imaging services and sleep disorder services to AIM Specialty Health (AIM). Announce changes with our ongoing process to collect health documentation and medical records for members who have purchased health plans on the exchange (also called the federal Health Insurance Marketplace) as required by the Affordable Care Act (ACA). Anthem in Virginia delegates management of outpatient advanced diagnostic imaging and sleep disorder services to AIM This newsletter contains several related articles addressing the transition of the management of outpatient advanced diagnostic imaging services and sleep disorder services to AIM Specialty Health as follows: Virginia imaging and sleep disorder management programs moving to AIM AIM online registration for professional and facility providers Radiology and cardiology frequently asked questions (FAQs) Sleep disorder management FAQs Schedule of webinars to address upcoming transition to AIM May 2015 2 of 18
New incentive opportunity for physicians in Virginia treating patients who have purchased plans on or off the exchange To comply with requirements of the Affordable Care Act, we continue our efforts to obtain health documentation through health assessments and medical record reviews for those members who have purchased health plans on or off the exchange. To this end, we engaged Inovalon a vendor and independent company that provides secure, clinical documentation services to help us with this ongoing effort by contacting physicians offices and our members regarding the need for health assessments. In this edition of the Network Update, learn how physicians in Virginia can receive incentives for completing health assessments for identified members. Watch for further updates Watch for more updates regarding the AIM transition and the Inovalon effort. We ll include information in our standard communications vehicles our Network Update provider newsletter and on Point of Care, our secure Web-based provider tool. In addition, we ll post information to the Virginia provider section of anthem.com. (As a reminder, access to Point of Care is through the single sign-on function via Availity another one of our secure online tools.) We will also use our e-mail service, Network eupdate, to communicate critical updates as needed. If you are not yet registered to receive Network eupdates, we encourage you to enroll now so you will receive all information shared about the AIM transition and other important topics. To register, visit anthem.com > Providers > Virginia > Network eupdate or click HERE. May 2015 3 of 18
Business update Virginia imaging and sleep management programs Anthem Blue Cross and Blue Shield in Virginia is dedicated to meeting the evolving needs of our members and trying to help ensure that they have access to the most appropriate care possible. Anthem will be delegating the management of outpatient advanced diagnostic imaging services and sleep testing and treatment services to AIM Specialty Health (AIM). The AIM programs will become effective beginning with procedures scheduled on or after July 1, 2015. All providers within our service areas of Virginia will be required to obtain an order number from AIM before scheduling any elective outpatient procedures included in the program. AIM Specialty Health is a leading specialty benefits management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty drugs. The company s mission is to make health care services more clinically appropriate, safer and more affordable. As such, AIM promotes the most appropriate use of specialty care services through the application of evidence-based clinical guidelines delivered via an innovative platform of technologies and services. The management programs will apply evidence-based clinical guidelines and Anthem s coverage guidelines for certain elective, outpatient advanced imaging and sleep services as follows: Imaging services CT, MRI, Nuclear Cardiology, PET, and Echocardiography exams Sleep services Home sleep test (HST); In-lab sleep study (PSG); Titration study; Initial treatment order (APAP, CPAP, BPAP); and Ongoing Treatment Order (APAP, CPAP, BPAP) A full list of the CPT and HCPCS codes included under this program can be found on our website at www.anthem.com. The list may be updated from time to time to reflect changes published by the American Medical Association in the CPT and HCPCS Manual. Beginning June 15, 2015, you may contact AIM to request order numbers by phone or online: Call AIM toll free at 1-866-789-0158 (weekdays, 8 a.m. to 5 p.m. EST) Use AIM s ProviderPortalSM at www.providerportal.com. If you already use AIM s Web portal, there is no need to register again. If you are new to AIM, please register at www.aimspecialtyhealth.com/goweb. May 2015 4 of 18
AIM online registration for professional and facility providers What does this change mean to providers? On May 15, 2015, we will begin collecting information about the imaging capabilities of all Anthem in Virginia contracted providers who provide the technical component of imaging services (Computed Tomography CT/CTA, Magnetic Resonance Imaging MRI/MRA, Nuclear Cardiology, and Positron Emission Tomography PET). The data you provide will become an important part of the information available to ordering physicians and members. AIM s online registration tool, OptiNet, will collect modality-specific data on imaging providers in areas such as: facility qualifications, technician and physician qualifications, accreditation, equipment, and technical registration. This information is used to determine conformance to industry-recognized standards, including those established by the American College of Radiology (ACR) and the Intersocietal Accreditation Commission (IAC). The provider registration is available online at www.aimspecialtyhealth.com/goweb. Simply select Anthem BCBS VA from the drop down menu. Only those providers who have completed the provider registration will be able to view their information online. Site information became available for review online starting March 1, 2015. All facilities need to complete their registration to have their site included in the online directory. If you have questions or need help completing the registration, please call AIM Customer Service toll free at 1-800-252-2021. If you have already completed the registration in connection with another health plan, you do not need to re-enter your information. Please review what has been prepopulated, make any updates, and submit your information to register for Anthem in Virginia. To copy your registration, select Copy from the Actions column on the site list after you log in and follow the steps when prompted. The online registration tool was designed with convenience in mind. You can save your data as you go which means you will not need to complete it in one sitting. To assist you in gathering the information needed to complete the registration, a checklist of the information required is available on the Anthem website UM Resources Link. These resources will also be accessible on AIM s ProviderPortalSM website (accessible via www.aimspecialtyhealth.com/goweb ). Once you complete the registration, the tool will remain available so you can update your information at any time. We recognize your office is busy, and we appreciate the time spent completing the registration. May 2015 5 of 18
Radiology and cardiology services administered by AIM Specialty Health FAQs Beginning July 1, 2015, Anthem Blue Cross and Blue Shield in Virginia will require prospective clinical case review (preauthorization) for outpatient, non-emergent imaging for Anthem members. AIM currently administers this program for Anthem HealthKeepers Plus (Medicaid/FAMIS) members. This change impacts all Anthem and HealthKeepers members with the exception of members enrolled in the Blue Cross Blue Shield Service Benefit Plan, also known as the Federal Employee Program (FEP). In addition, some national accounts may be excluded. Please contact Anthem in Virginia if you need additional information regarding products covered under the program. The following services are included in the program: Computed Tomography (CT/CTA), including cardiac Magnetic Resonance (MRI/MRA), including cardiac Positron Emission Tomography (PET) Scans, including cardiac Nuclear Cardiology Stress Echocardiography (SE) Resting Transthoracic Echocardiography (TTE) Transesophageal Echocardiography (TEE) Frequently asked questions (FAQs) Prospective case review will be handled by AIM Specialty Health (AIM). This document provides responses to the most frequently asked questions. 1. When will this program begin? Beginning July 1, 2015, AIM s call center and website ProviderPortalSM are available for submission of order requests for imaging services occurring on or after July 1, 2015. 2. How does a physician s office staff member obtain an order number from AIM? There are two ways to obtain an order number for diagnostic imaging services: You may contact AIM online via AIM s ProviderPortal at www.aimspecialtyhealth.com/goweb (select Anthem BCBS VA from the drop-down menu) or call toll free at 1-866-789-0158 (weekdays, 8 a.m. to 5 p.m. EST). AIM does not accept requests via fax. May 2015 6 of 18
3. How does the Anthem in Virginia program work? Ordering physicians offices submit order requests through ProviderPortal AIM s interactive Internet application or through the AIM Call Center. Web users or callers will be guided through an interview where member and ordering physician information, diagnosis, symptoms, exam type, and treatment/clinical history will be requested. If the information provided meets AIM s clinical criteria and is consistent with Anthem s guidelines, the Web user/caller will then be guided to select an imaging provider where the imaging study will be performed, and an order number will be issued. If the review is not consistent with applicable criteria, additional review will be necessary. The case is first forwarded to a nurse reviewer who uses additional clinical experience and knowledge to evaluate the request. The nurse reviewer has the authority to issue order numbers in the event that he or she is able to ensure that the request is consistent with AIM s clinical criteria and Anthem guidelines. If the nurse reviewer cannot issue an order number, then the case is transferred for physician review and the ordering provider is given an opportunity to have a peer to peer conversation with the AIM physician reviewer. In the event that the AIM physician reviewer cannot approve the case, the physician reviewer will issue a denial for the request. 4. What does the AIM order number look like? AIM s order numbers are eight numeric digits. 5. How long is an order number valid? An order number issued by AIM is valid for 30 days. 6. Can AIM handle multiple requests per call? Yes, imaging requests for multiple members can be made on the same call. 7. Does AIM need to know when the procedure is scheduled? No, although the order number should be issued prior to scheduling the study. Retrospective reviews for more than two business days will not be accepted. Review of services already rendered will be reviewed by the health plan prior to claim payment. All contract provisions for authorization requirements will apply for Anthem HealthKeepers members. 8. Will members be able to contact AIM? Members should contact Anthem in Virginia directly if they have any questions. May 2015 7 of 18
9. What information will AIM require in order to evaluate an imaging request? Please refer to the checklist below for all the necessary information prior to submitting a request to AIM: Member s identification number, name, date of birth, and health plan Ordering provider information Imaging provider information Imaging exam(s) being requested (body part, right, left or bilateral) Patient diagnosis (suspected or confirmed) Clinical symptoms/indications (intensity/duration) For most situations, the preceding information will suffice. For complex cases, more information may be necessary, including: Results of past treatment history (previous tests, duration of previous therapy, relevant clinical medical history) 10. How can I determine whether an order number has been obtained for a member? Servicing providers will be able to contact AIM to determine whether an order number has been obtained for a member covered under the programs. Providers can access this information via the ProviderPortal. 11. What happens if a member is approved for a specific procedure (for example: CT of the abdomen) and during the course of this procedure, the radiologist or rendering provider determines that an additional procedure requiring pre-authorization (for example: CT of the pelvis) is also needed? The radiologist or rendering provider should proceed with the additional procedure. If this occurs, he or she should inform the member s ordering provider that an additional test was performed on the same day. AIM must be contacted for an order number for the additional procedure no later than two business days after the services were rendered. The pertinent clinical information supporting the additional procedure must be available at the time AIM is contacted. Contract provisions for authorization requirements will apply for Anthem HealthKeepers members. 12. If AIM denies prior authorization of an imaging exam, is there an option to request a reconsideration and/or appeal the decision? Yes, you may request a reconsideration or appeal through Anthem s normal procedures, as directed in the denial letter. Anthem in Virginia retains the responsibility for reconsiderations and appeals. 13. If AIM has already authorized a service and the service needs to be rescheduled beyond the original 30-day authorization period, do I need a new order number? If the date of the service is extended beyond the original 30 days, a new order number must be requested through AIM. May 2015 8 of 18
14. If the authorization is done via the telephone or via the ProviderPortal, is a letter sent to the provider whether the request was approved or denied? Yes, approval or denial letters will be sent to ordering providers, servicing providers and to the member requesting preauthorization of high-tech radiology imaging services. 15. What pre-exam questions (PEQs) will be asked and why is Anthem requesting this information? Anthem requests that the ordering provider complete a set of voluntary PEQs for cardiac exams [including Cardiac CT/CTA, Cardiac PET, Myocardial perfusion imaging (MPI), and Stress Echocardiogram (SE)]. For example, the following voluntary questions will be asked for MPI and SE: A. Differential diagnosis B. Does the patient have established coronary artery disease (CAD)? If yes, please indicated which exams were performed and when. Myocardial Infarction Angioplasty, stenting, or bypass Catheterization showing >70% stenosis C. Does the patient have chest pain? If yes, please provide additional information (nature/description/location). D. Does the patient have any additional symptoms? If yes, please describe the additional symptoms. E. Patient Risk Assessment Current Weight Current Blood Pressure Current Smoker Current Total Cholesterol Co-existing Conditions [Diabetes, Abdominal Aortic Aneurysm, Symptomatic Peripheral Vascular Disease, History of cerebrovascular accident (CVA), transient ischemic attach (TIA), carotid endarterectomy (CEA), and Renal Insufficiency/Failure] Family History of CAD (Father/Brother/Son <50 years old, Mother/Sister/Daughter <60 years old) F. When did the patient last receive an EKG? Please provide the results of the most recent EKG test. G. Is the patient able to walk on a treadmill? May 2015 9 of 18
H. Has the patient received any cardiac exam/test in the last two years? If yes, please provide the date and results for the exam(s). Exercise Stress Test MPI SE Coronary CT Angiography Cardiac Catheterization I. Pre-operative evaluation (if performing surgery please indicate type and date) J. Does the patient have a history of heart transplant? PEQs are being included in the review process for cardiac imaging exams to risk-stratify patients by identifying the common risk factors for cardiac disease. The PEQs address blood pressure, lipid status, tobacco use, and diabetes. 16. If I do not complete the pre-exam questions will the results of my order request for cardiac imaging services be impacted? While the completion of the PEQs for Cardiac CT/CTA, Cardiac PET, MPI and SE is currently voluntary, it is important to note that completed PEQs facilitate the order review process, as these exams are used to assess the risk of CAD. Completing the PEQs for these exams will reduce the time it takes to receive your order number. Since there is no correlation between CAD and all other cardiac exams (TTE, TEE, Blood Pool Imaging/MUGA, and Cardiac MRI), PEQs for adult patients are not included. In addition, because the PEQs do not currently take age into consideration they will not be requested for pediatric patients (under the age of 19). 17. How do I complete the PEQs? The PEQs are completed when submitting your request for an order number for cardiac imaging services. 18. Who develops the clinical criteria for the program? AIM s Clinical Appropriateness Guidelines are updated at least once a year and are reviewed by: An independent physician review board, which may include cardiologists, orthopedic surgeons, radiologists, neurologists, and neurosurgeons Client medical directors Physician review panels May 2015 10 of 18
Anthem has been using these guidelines for several years. In addition, AIM s guidelines are submitted as part of AIM s accreditation process to the National Committee for Quality Assurance (NCQA) and the American Accreditation HealthCare Commission (URAC). 19. What methods and resources are used to develop the guidelines? Development of AIM s Clinical Appropriateness Guidelines involves integration of medical information from multiple sources to support the reproducible use of high quality and state-of-the-art diagnostic imaging services. The process for criteria development is based on technology assessment, peer-reviewed medical literature, including clinical outcomes research, and consensus opinion in medical practice. The primary resources used for AIM s Diagnostic Imaging Clinical Guidelines development include: American College of Radiology (ACR) Appropriateness Criteria American College of Cardiology (ACC) Appropriateness Criteria American Heart Association (AHA) American Institute of Ultrasound in Medicine (AIUM) American Cancer Society American Academy of Neurology (AAN) American Academy of Pediatrics (AAP) Society of Interventional Radiology (SIR) Society of Nuclear Medicine (SNM) Agency for Healthcare Research and Quality (AHRQ) Centers for Medicare and Medicaid Services (CMS) National Guideline Clearinghouse 20. How can I receive a copy of the clinical criteria AIM uses? AIM Clinical Appropriateness Guidelines are available on the homepage of their website at www.aimspecialtyhealth.com. To request a copy of the guidelines, please contact AIM toll free at 1-800- 252-2021, Monday through Friday, 8 a.m. to 5 p.m. EST. May 2015 11 of 18
21. What review tools are available to me? Review tools to assist with your requests can be found on www.anthem.com or the AIM site listed below. http://www.anthem.com/wps/portal/ahpprovider?content_path=provider/va/f4/s0/t0/pw_m008767.htm&label=utilizatio n Management Resources&rootLevel=3&state=va&label=UM Resources http://www.aimspecialtyhealth.com/ 22. The Anthem in Virginia Radiology Center closes on June 30, so how will radiology/cardiology requests be handled going forward? The current Anthem radiology/sleep call center closes at 5 p.m. on June 30, 2015. Beginning July 1, 2015, calls will be directed to AIM Specialty Health for service requests on or after July 1, 2015. All authorization requests for services prior to July 1, 2015, will need to be submitted for review by close of business on June 30, 2015. If not received before close of business on June 30, 2015, you will need to submit your claim and it will be reviewed prior to claim payment. OptiNet registration for sleep disorder management FAQs The following section addresses common questions about the registration process through AIM Specialty Health s online application OptiNet regarding sleep disorder services. Frequently asked questions (FAQs) 1. What is AIM Specialty Health (AIM)? AIM Specialty Health is a leading specialty benefits management company with more than 20 years of experience and a growing presence in the management of radiology, cardiology, oncology, sleep medicine, and specialty pharmacy. The company s mission is to make health care services more clinically appropriate, safer and more affordable. As such, AIM promotes the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. 2. What is the OptiNet registration tool? OptiNet is an online provider registration tool that collects information on the facility, such as, accreditation status. The data you provide will become an important part of the information available to ordering physicians and members. May 2015 12 of 18
3. Why is Anthem in Virginia requesting this registration? As consumers and providers look for tools to support informed decision-making, Anthem s goal is to be able to provide accurate and current information about sleep testing and therapy providers to ordering physicians and their patients. The goal of the registration is to gather information about the sleep testing and therapy capabilities within the network. Anthem is asking all providers who provide sleep testing and therapy services for Anthem members to complete the registration. 4. Are durable medical equipment (DME) suppliers also required to complete the OptiNet registration? Yes, DME suppliers are required to complete the OptiNet registration. 5. How often will I be asked to participate in the registration process? Providers will receive an e-mail notification when their registration information is expiring. If changes to provider capabilities occur prior to this time, providers may update their information using the online tool, OptiNet, at any time. 6. How do I access the registration? The registration tool will be available via www.aimspecialtyhealth.com/gowebsleep on May 15, 2015. OptiNet allows you to complete the registration at your convenience; it can be initiated, paused and saved as necessary. If you have not already done so, register with AIM at www.aimspecialtyhealth.com/gowebsleep in order to access the tool. 7. What information do I need to have to complete the online registration? Site and contact information: Verify your facility address and designated contact person. Services information: Enter available services provided at this address, accreditations, type of facility. Staff information: Enter each physician s specialty, board certification and expiration date. 8. How will I know if I have submitted everything necessary for my registration to be considered complete? Once the registration has been submitted through OptiNet, your office will receive an e-mail detailing your status and a registration number. If you have submitted all the required information, this e-mail will confirm completion. If AIM requires further information, an e-mail will be sent to you indicating that AIM will contact you. 9. What if a new physician enters my practice after registration for my site is complete? If a new physician enters your site or facility, you should log in to the OptiNet application and add the physician to the list of physicians associated with your location. May 2015 13 of 18
10. How do I navigate within OptiNet? The tabs and road map along the top of the OptiNet screen allow you to display the desired page. You can also move through the pages in order by clicking the Next and Save and Continue buttons, or you can skip to the desired page once a section has been saved by clicking the appropriate road map links and tabs. 11. Can I use my Web browser s Back button to go back a page? It is not recommended. You may lose your connection to OptiNet. Use the Back buttons at the bottom left corner of the pages when available. The Cancel button also backs you out of a page and displays the previous one. 12. Can I interrupt an OptiNet session and save what I have entered for later? Yes. When you use OptiNet you always start from the beginning. The information that you have already entered will be retained for future sessions as long as you save what you have entered. When you return to OptiNet, this information will be displayed as you entered it, so you can move quickly through the pages either leaving the information as is, or making changes as you go. 13. How do I use the online help in OptiNet? Please click the Help tab at the right of the page to display a Helpful Tips panel. 14. What if I need additional help? At the bottom of every Helpful Tips panel is an Advanced Help link. Click this link to launch the full OptiNet online help system. If you still have a question, use the Customer Service link at the bottom of any page to e-mail AIM Customer Support with your questions. 15. What should I do if my site is not listed, is misspelled, or is missing information? Please contact AIM Customer Service toll free at 1-800-252-2021. 16. My site is already accredited by the American of Sleep Medicine (AASM) the Accreditation Commission for Health Care (ACHC) or the Joint commission. Should I still complete the registration? Yes, we are requesting that you complete the registration despite having AASM, ACHC, or Joint Commission accreditation. 17. If I have more than one facility, do I need to complete the registration for each site? Yes, you will need to register for each location. However, if information is similar for more than one location, you will be able to copy the registration for one site, once it is complete, for your other locations. 18. What will Anthem in Virginia do with the information collected in this registration? Beginning on May 15, 2015, information gathered from the OptiNet registration will be made available to ordering physicians during the sleep management request process. The accreditation information you submitted through May 2015 14 of 18
OptiNet will determine the site score that will be assigned. The site score, as well as the average allowed payment amount and distance from the member s home, will be displayed. For ordering physicians, the information collected will be used to educate users in the Provider Selection component of the order request process. Ordering physicians will be able to choose a servicing provider from the online directory based on their ability to provide home sleep testing, facility-based sleep testing and DME services. Those providers who indicate they are accredited in their registration will be designated as such in the display. All facilities need to complete the registration to have their site included in the online directory. When Anthem patients are identified for a facility-based or in-lab sleep study (also known as PSG), titration, splitnight, multiple sleep latency test (MSLT) or maintenance of wakefulness test (MWT), they will be given the option to select a location that has the same site score but is more cost effective for them. 19. What happens if I decide not to register? If providers who perform sleep therapy and/or testing services do not complete the registration, their facility information will not be made available to ordering physicians during Provider Selection when submitting a request for sleep services through AIM. 20. What is the time frame for completing my registration? All sleep testing and therapy providers, including DMEs suppliers, should complete their registration as soon as possible. However, there is no set time frame for completion. For additional FAQs related to AIM s Sleep Solution, go to www.aimspecialtyhealth.com/gowebsleep. Click on the link for Sleep Management Frequently Asked Questions. AIM Specialty Health webinars offered beginning June 9 As we continue our ongoing efforts to help ensure our members have access to the most appropriate care possible, Anthem is introducing a new program for imaging services to be administered by AIM Specialty Health (AIM) beginning July 1, 2015. AIM will handle the management of outpatient advanced diagnostic imaging services and sleep management services for Anthem beginning July 1. In preparation for the launch of this new effort, we are working with AIM to host a number of webinars to help make the transition a smooth one for our provider community. These webinars will share information needed for obtaining an order number from AIM before scheduling any elective outpatient advanced diagnostic imaging procedures and other need-to-know information impacting your office or facility. Several webinars will be offered so please select one that s convenient for you and your staff. The webinar schedule is available on Point of Care our Web-based provider tool. For your easy reference, we ve included the AIM webinar schedule on the next page. May 2015 15 of 18
Schedule of AIM webinars June 2015 WebEx Dial-in Information Toll-free, Call-in Number (All Sessions): 1-877- 668-4490 (United States/Canada) Access Code: 622 591 175 Password (if prompted): aim WEBINAR ATTENDEES MUST HAVE INTERNET AND SIMULTANEOUS TELEPHONE ACCESS. ANTHEM WEBINAR SCHEDUE FOR AIM PROGRAM DATE TIME ONLINE LINK Tuesday, June 9, 2015 10 a.m. to 11 a.m. ET Join WebEx meeting Tuesday, June 9, 2015 2 p.m. to 3 p.m. ET Join WebEx meeting Thursday, June 11, 2015 10 a.m. to 11 a.m. ET Join WebEx meeting Thursday, June 11, 2015 2 p.m. to 3 p.m. ET Join WebEx meeting Tuesday, June 16, 2015 10 a.m. to 11a.m. ET Join WebEx meeting Tuesday, June 16, 2015 2 p.m. to 3 p.m. ET Join WebEx meeting Tuesday, June 23, 2015 10 a.m. to 11 a.m. ET Join WebEx meeting Tuesday, June 23, 2015 2 p.m. to 3 p.m. ET Join WebEx meeting May 2015 16 of 18
Health care reform (including health insurance exchange) New incentive opportunity for physicians in Virginia: Receive incentives for each properly completed SOAP Note for identified members with health plans purchased on or off the exchange As part of our compliance with the Affordable Care Act (ACA), Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers, Inc. are updating the health documentation for our member population. This effort applies to our members who have purchased health plans on or off the Health Insurance Marketplace or commonly referred to as the exchange. To comply with ACA requirements, we re asking physicians to conduct health assessments for select members. The information we are gathering will help us determine an appropriate risk profile and provide a clearer picture of these members health. Anthem is working with Inovalon a vendor and independent company that provides secure, clinical documentation services to contact physicians on our behalf. Throughout the benefit year, Inovalon may contact you to conduct patient assessments and to submit your findings to Inovalon using the vendor s secure, electronic tool called epass OR by using the Encounter Subjective, Objective, Assessment and Plan (SOAP) Note provided with mailings Inovalon sends for each identified patient. To help make the process easier for you, Inovalon will include the following in packages the vendor mails should one or more of your Anthem patients be identified for a patient assessment: A convenient scheduling list to help you schedule appointments with your Anthem patients An epass bookmark with step-by-step instructions for using the Web-based tool A paper SOAP Note for each patient identified containing that patient s clinical profile and recent claims history if you prefer a paper form; and An instruction form for completing the paper SOAP Note Opportunity to increase reimbursement Incentives We understand that completing these requests may take time, and we would like to offer you the opportunity to increase your reimbursement. Beginning with patient assessments completed for dates of service on or after March 1, 2015, you are eligible to receive $100 in addition to your office visit fee for each properly submitted electronic SOAP Note submitted through Inovalon s epass tool. You may also elect to submit your patient assessment data for the members we request using the paper SOAP Note option. Just send the paper SOAP Note to Inovalon s secure fax line at 1-866-682-6680. For each paper SOAP Note properly submitted for patient assessments performed, you will receive $50 in addition to your office visit fee. May 2015 17 of 18
Tips on completing SOAP Notes We ask that you fully complete the SOAP Notes, addressing all questions as appropriate whether using epass for electronic entry or via the paper method. Here are some tips for completing SOAP Notes: The exam date for the patient must match the exam date on the completed SOAP Note A claim must be submitted for the exam and the date of service on the claim must match the exam date on the completed SOAP Note The provider signature date should be the actual date the SOAP Note is signed All mandatory fields on the paper SOAP Note must be completed The exam date must occur between March 1, 2015, and December 31, 2015, for this benefit year All mandatory fields on the paper SOAP Note must be completed to be eligible for incentive payment Incentives are only paid once for each patient for whom a health assessment was requested. Questions If you have questions about Inovalon, the outreach process, completing SOAP Notes correctly or using epass, please refer to the frequently asked questions document on our website at anthem.com just select this LINK. Or, if you prefer, you can contact Inovalon directly toll free at 1-877-448-8125. May 2015 18 of 18