Working with Anthem Subject Specific Webinar Series Special Session Working with Anthem Medicaid Access audio conference: 877-497-8913 Conference code: 132-281-9809# 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 11.30.16
Special Session Working with Anthem Medicaid Agenda Housekeeping and announcements WI Medicaid counties Anthem Provider Guide walk-through Resources and tools Member ID card Call center Claims Claim payments Prior authorization / precertification Reimbursement Policies Appeals Service partners Revision date 11.30.16 2
Special Session Working with Anthem Medicaid Agenda continued Public and secure web portals 2016 Provider satisfaction surveys Learn more Questions and answers Feedback survey Revision date 11.30.16 3
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 11.30.16 4
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 11.30.16 5
WI Medicaid counties Southeastern Counties Kenosha Milwaukee Ozaukee Racine Washington Waukesha Expansion Counties Brown Kewaunee Rock Calumet Langlade Shawano Dane* Manitowoc Sheboygan Dodge Marinette Taylor* Door Marquette* Walworth Florence* Menominee* Waupaca Fond du Lac Oconto Waushara Forest Outagamie Winnebago Green Lake Polk* Wood Jefferson Portage * New counties effective July 1, 2016 Revision date 11.30.16 6
WI Medicaid counties map * New counties effective July 1, 2016 Revision date 11.30.16 7
Anthem Provider Guide walk-through Revision date 11.30.16 8
Resources and tools Anthem Blue Cross and Blue Shield (Anthem) provider website Member identification (ID) card Call center Claims payments Remittance advice Reimbursement policies Prior authorization Appeals Service partners Ready reference guide: telephone numbers and websites Provider Directory Revision date 11.30.16 9
Member ID card Anthem Medicaid member ID numbers Anthem ID numbers for Medicaid members begin with alpha prefix ZRA Does not incorporate the Medicaid ID number Anthem ID cards issued to members ID cards are formatted similarly to commercial Anthem cards Plan name in upper-right corner will be Medicaid Member ForwardHealth ID indicated on front of card Revision date 11.30.16 10
Member ID card continued Revision date 11.30.16 11
Call center Anthem Provider Services: 1-855-558-1443 Provider Services handles eligibility, claims and prior authorization Select the appropriate self-service options based upon the date of service and the topic: Member eligibility and PCP assignment Claim status Claim payments Precertification: requests, requirements and check status Revision date 11.30.16 12
Claims Submit with Medicaid ID or Anthem ID Submit paper claims to the following address: Anthem Blue Cross and Blue Shield Claims Department P.O. Box 61010 Virginia Beach, VA 23466 1010 Revision date 11.30.16 13
Claims continued Claims Submission Requirements Providers with multiple ForwardHealth certifications with the same NPI: Anthem Medicaid s claims processing system will look for unique billing provider identifying information first, Taxonomy code, if reported, and then for a unique Zip + 4. State-certified Taxonomy code is a key identifier for the claims process and providers are encouraged to report it on the claim form. Do not submit a P.O. Box in the Billing Provider Address field Revision date 11.30.16 14
Claims payments Claims payments are incorporated into Anthem s checks and electronic fund transfers (EFT). For information on EFT and electronic remittance advice (ERA): Go to https://www.anthem.com/home-providers.html and select Wisconsin. Under the Self Service and Support heading, select Electronic Data Exchange (EDI). From there, select Register in the top menu. Revision date 11.30.16 15
Prior authorization / precertification Precertification requirements provider website: Use CPT code lookup tool to verify precertification requirements High-tech radiology and echoes: AIM Specialty Health Therapy and spine care: OrthoNet LLC Revision date 11.30.16 16
Prior authorization / precertification Prior authorization Revision date 11.30.16 17
Reimbursement policies https://mediproviders.anthem.com/wi/pages/reimbursementpolicies.aspx Revision date 11.30.16 18
Medical policies and UM guidelines www.anthem.com/cptsearch_shared.html Revision date 11.30.16 19
Appeals Submit appeals to the following address: Anthem Blue Cross and Blue Shield Claim Appeals Department P. O. Box 61599 Virginia Beach, VA 23466 1599 Reminder: All providers must be Medicaid certified Submit claims with Medicaid-certified tax ID, NPI and nine-digit ZIP code to avoid denials Medicaid certification via the ForwardHealth portal Revision date 11.30.16 20
Service partners Dental DentaQuest for members in the following counties: Kenosha, Milwaukee, Ozaukee, Racine, Washington or Waukesha Contact DentaQuest at 1-855-453-5287; fax 1-262-834-3589 Fee-for-service Medicaid in all other counties in the state of Wisconsin Revision date 11.30.16 21
Service partners continued Vision Vision services including eye exams, glasses and treatment for diseases or injury to the eyes are covered through MARCH Vision Care Contact MARCH Vision Care at 1-888-493-4070 Pharmacy Most Member prescriptions and certain over-the-counter items are covered by Medicaid fee-for-service, except when administered in the facility setting. Revision date 11.30.16 22
Public Provider Websites Medicaid Provider Website www.anthem.com/wimedicaiddoc Home Page News and Announcements Useful Publications Vertical Menu Claims Precertification Medical Provider Education Find a Doctor Other Services Revision date 11.30.16 23
Public Provider Website Medicaid Provider Website www.anthem.com/wimedicaiddoc Vertical Menu Claims Claim Forms Reimbursement Policies Revision date 11.30.16 24
Public Provider Website Medicaid Provider Website www.anthem.com/wimedicaiddoc Vertical Menu Precertification Revision date 11.30.16 25
Public Provider Websites Medicaid Provider Website www.anthem.com/wimedicaiddoc Vertical Menu Medical Forms Disease Management Centralized Care Unit Behavioral Health Clinical Practice Guidelines Revision date 11.30.16 26
Public Provider Website Medicaid Provider Website www.anthem.com/wimedicaiddoc Vertical Menu Provider Education Manuals, Directories, Training & More Communications & Updates Revision date 11.30.16 27
Public Provider Website Medicaid Provider Website www.anthem.com/wimedicaiddoc Vertical Menu Tutorials, Reference Guides & Other Resources Ready Reference Guide Expansion Counties Ready Reference Guide South East Counties Revision date 11.30.16 28
Public Provider Website Medicaid Provider Website www.anthem.com/wimedicaiddoc Vertical Menu Find a Doctor Other Services Dental Vision Revision date 11.30.16 29
Secure Provider Website Access via Availity My Payer Portals Choose Provider Portal (MyAnthem Provider commercial) Choose Medicaid Provider Self Service (Anthem) Choose Medicare Advantage Provider Self Service (Anthem) Revision date 11.30.16 30
Secure Provider Website 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 11.30.16 31
Learn more https://mediproviders.anthem.com/documents/wiwi_caid_provider_ Guide.pdf https://mediproviders.anthem.com/documents/wiwi_caid_provider_ Manual.pdf https://mediproviders.anthem.com/documents/wiwi_caid_readyref erenceguide_expansioncounties.pdf https://mediproviders.anthem.com/documents/wiwi_caid_readyref erenceguide_secounties.pdf Revision date 11.30.16 32
Special Session Working with Anthem Medicaid Questions? Revision date 11.30.16 33
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 email on the 3 rd business day 34
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.