In this issue Page. anthem.com. Important phone numbers. May 2013

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1 May 2013 In this issue Page Announcements New requirement for credentialing of physical, occupational and speech therapists effective August 1, Important notice for network-participating physicians regarding reimbursement 3 Coverage and clinical guideline update Clinical guideline update effective August 1, Business update Commonwealth of Virginia issues new ID cards 5 New 2013 CPT codes classified as bundled services 7 Update on clinical reviews: MCG update 7 Proper antidepressant medication prescribing helps aid patient compliance 8 Anthem s Condition Care Program 9 We believe in continuous improvement 10 Case Management Program 10 Clinical practice and preventive health guidelines available on the Web 11 Coordination of care 11 How to obtain language assistance 12 Important information about utilization management 13 Members rights and responsibilities 14 Health care reform updates and notifications Breast pumps covered under preventive care benefits 15 Site launched to educate on health care reform 16 ICD-10 update ICD-10 Tip: You don t have to learn the entire code set 17 ebusiness Availity : Multi-payer portal 18 Sign up for alerts via Network eupdate 19 anthem.com Important phone numbers 1 of 34 VAPENABSNL (05/13)

2 In this issue, continued Page Medicaid update Change to immunization administration for Medicaid 19 Medicare information Notice of Medicare non-coverage requirements 20 Precertifications, observation and timely notification reminders for Medicare Advantage members 21 Medicare Advantage members receive personalized checklist for preventive services 22 SilverSneakers Fitness Program helps older members stay active 23 Anthem took action to spread the word about increased flu activity 23 Annual medical chart review program for Medicare Advantage members under way House Call Program for Medicare Advantage members launches 24 Global surgical modifiers on Medicare Advantage claims 25 Pharmacy update Pharmacy information available on anthem.com 26 Bulletin board Medical office seminars and webinars on tap Medical Office Seminar Schedule Medical Office Seminar Registration Form Medical Office Webinar Registration Form Medical Office Webinar Schedule Community involvement and events 33 May of 34

3 Announcements New requirement for credentialing of physical, occupational and speech therapists effective August 1, 2013 Beginning August 1, 2013, Anthem will require credentialing of new physical therapists, occupational therapists and speech therapists who are listed under an individual entity within the Anthem network directories. Anthem will reach out to existing providers who are currently listed as an individual entity over the next several months to initiate the credentialing process. To assist in getting the process started, please review the steps noted below. Use of the Council for Affordable Quality Healthcare s (CAQH) application is required. This is a free, online service that allows health care providers to fill out ONE application to meet the credentialing data needs of multiple organizations. Providers will receive notice from CAQH requesting completion of a credentialing application. If you are already using CAQH, the organization will remind you to update your application and to authorize Anthem to view your credentialing information. Please watch for these notices from CAQH so there is no disruption in your provider directory listing. Practitioners who do not have Internet access may submit their application via fax to CAQH by first contacting the CAQH Help Desk toll free at Once you have completed your application, credentialing involves verification of basic professional conduct and competency criteria including licensure, education and training, and sanction activity. Once credentialing is complete, your credentials are reviewed by a local credentialing committee or medical director for approval. Re-credentialing occurs every three years thereafter via the same process. Below are some helpful hints and things to remember when using CAQH: Have your CAQH provider ID ready in order to complete the online application. As noted, CAQH sends this CAQH ID to you once Anthem adds you to our provider roster (unless you already have one). Go to to register your CAQH provider ID and complete your credentialing application. Important notice for networkparticipating physicians regarding reimbursement As a reminder, under no circumstances should any physician collect reimbursement from any source other than Anthem Blue Cross and Blue Shield and HealthKeepers Inc. for Covered Services rendered to their Covered Individuals. This includes, but is not limited to, process and handling fees that vendors such as laboratories may offer physicians. In accordance with obligations defined in paragraph of the Anthem provider agreement: Provider shall only look for payment (except for applicable Cost Share or other obligations of Covered Individuals) from the Plan that provides the Health Benefit Plan for the Covered Individual for Covered Services rendered. Non-compliance with this provision is a breach of contract and could result in termination of the agreement. This notice applies to all lines of business for Anthem and HealthKeepers Inc. including the companies PAR/PPO plans, HealthKeepers plans, Medicare Advantage plans, and the Blue Cross Blue Shield Service Benefit Plan [also known as the Federal Employee Program (FEP)]. May of 34

4 Ensure that you authorize Anthem to access your credentialing information. Anthem can then begin the credentialing process. These steps are NOT required if you chose global authorization. To authorize: 1. Go to enter your user name and password 2. Click the Authorize tab 3. Scroll down, locate Anthem and check the box beside Anthem 4. Click Save to submit your changes. For questions about CAQH, call the CAQH help desk toll free at Coverage and clinical guideline update Clinical guideline update effective August 1, 2013 Clinical Utilization Management (UM) Guideline Wheeled Mobility Devices: Wheelchairs Powered, Motorized, With or Without Power Seating Systems and Power Operated Vehicles (POVs) (CG-DME-31) was revised and approved at the Medical Policy and Technology Assessment Committee meeting held on February 14, Anthem Health Plans of Virginia, Inc. d/b/a Anthem Blue Cross and Blue Shield (hereinafter Anthem ) will implement this revised clinical UM guideline effective August 1, Revisions include the addition of medically necessary and not medically necessary clinical indications for power seating systems as well as not medically necessary indications for wheelchair options/accessories which address seat lift mechanisms. HCPC codes added to the guideline for clinical review are E1009, E1010, and E2300. Precertification/Health Services Review will be required in advance for these services and applies to all members of Anthem s PAR, PPO Virginia plans as well as our HealthKeepers and HealthKeepers Plus plans for dates of service on or after August 1, The complete revised clinical UM guideline is available for review beginning April 16, 2013, on our website at May of 34

5 Business update Commonwealth of Virginia issues new ID cards The Commonwealth of Virginia will issue new plastic cards to members enrolled in the Commonwealth s COVA Care plan for state employees and early retirees along with Key Advantage plans under The Local Choice. These cards will be mass issued to members by a new vendor Clarity beginning mid-june Starting July 1, Anthem will be the administrator for the medical as well as the outpatient prescription drug and behavioral health/eap plans for COVA Care and TLC Key Advantage. Medicare ID cards remain unchanged and will not be mass re-issued. Please note that pharmacy information such as Rx Bin, Rx Group or phone numbers to call for pharmacist questions differs between the COVA Care/The Local Choice Key Advantage PPO plans and the COVA HDHP/TLC HDHP high deductible health plans. We ve included sample ID cards in this edition of the Network Update. The telephone numbers for each plan administrator will be shown on the back of the ID cards. The following illustrations present both COVA Care and TLC Key Advantage ID cards. As always, we suggest that you access Anthem Point of Care our secure Web-based provider tool to retrieve member eligibility details, benefits and other information about our COVA and other Anthem plans. May of 34

6 Sample COVA Care Plan ID Card Front Sample Key Advantage Expanded ID Card Front May of 34

7 Sample ID Card (both COVA Care and The Local Choice) Back New 2013 CPT codes classified as bundled services Several new 2013 Current Procedural Terminology (CPT ) codes have been added to the Bundled Services and Supplies policy. Codes (chronic care coordination services) and (transitional care management services), are integral components of the overall care provided to members. Therefore, these services are not eligible for separate reimbursement. Also, the new 2013 CPT codes 92921, 92925, 92929, 92934, 92938, and for percutaneous coronary services add-on services will be bundled services and not eligible for separate reimbursement. The Centers for Medicare & Medicaid Services (CMS) designates codes , and add-on codes 92921, 92925, 92929, 92934, 92938, and as Status B codes, and therefore bundle these services. Update on clinical reviews: MCG update Effective May 6, 2013, Anthem will transition to the most recent edition (17th) of the MCG guidelines (formerly Milliman Care Guidelines ). This may change some of the clinical information requested during the review process or adjustments to a length of stay. Our staff is happy to assist you in providing the information needed to complete a review of your request. In the case of an adverse decision, we can provide you with the area(s) of criteria that were not met. However, due to licensing restrictions, Anthem is unable to offer complete MCG documentation. You must obtain complete documentation directly from MCG Health, LLC. May of 34

8 Proper antidepressant medication prescribing helps aid patient compliance Proper antidepressant medication prescribing is an important component of practicing medicine regardless of the provider specialty. Patients taking antidepressant medication are about as likely to receive appropriate care today as they were in The American Journal of Managed Care conducted a survey of patients in an attempt to understand the reasons for early discontinuation of selective serotonin reuptake inhibitor medications. This study reports that the lack of communication from the prescriber with regards to medication duration and possible side effects is the number one reason for prematurely discontinuing the medication. Treatment needs to be supported by good prescribing habits, in part because antidepressant response tends to appear over weeks and in part because sustained treatment decreases the risk of symptoms re-appearing. Based on practitioner feedback, the National Committee on Quality Assurance (NCQA) modified the Antidepressant Medication Management measure in The Optimal Practitioner Contacts Rate was retired. The Effective Acute Phase Treatment and the Effective Continuation Phase Treatment that measures continuation on the antidepressant medication for 84 days and 180 days has remained unchanged. NCQA has defined the metric as the percentage of members 18 years of age and older who were diagnosed with a new episode of major depression and treated with antidepressant medication, and who remained on an antidepressant for medication treatment. Two rates are reported. Effective Acute Phase Treatment. The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 84 days (12 weeks). Effective Continuation Phase Treatment. The percentage of newly diagnosed and treated members who remained on an antidepressant medication for at least 180 days (six months). The most recent HEDIS rates for this metric indicate that Virginia scored below the 25 th percentile ranking according to the NCQA and that there is an opportunity to improve compliance with antidepressant medication adherence. Virginia members who are newly diagnosed with depression and have started treatment with an antidepressant medication receive an initial educational mailing. The mailing provides information on the importance of taking medications as prescribed and reporting side effects to the prescribing practitioner. Members, who are more than seven days late refilling their medications, receive an interactive voice response (IVR) call to encourage medication compliance. Beginning in March 2013, a physician notification of late refills was added to the Medication Review CMS. We hope that this new information is useful to you, as you work with our members regarding their health care. 1. American Journal of Managed Care, HEDIS Antidepressant Medication Management Measures and Performance-based Measures: An Opportunity for Improvement in Depression Care, Volume 13:S98-S102, November May of 34

9 Anthem s Condition Care Program Anthem members have additional resources available to help them better manage chronic conditions. The ConditionCare program is designed to help participants improve their health and enhance their well-being. The program is based on nationally recognized clinical guidelines and serves as an excellent adjunct to physician care. The ConditionCare program helps members better understand and control certain medical conditions like diabetes, COPD, heart failure, asthma and coronary artery disease. A team of nurses with added support from other health professionals such as dietitians, pharmacists and health educators work with members to help them understand their condition(s), their doctor s orders and how to become a better self-manager of their condition. Members are stratified into three different risk levels. Engagement methods vary by risk level but can include: Education about their condition through mailings, telephonic outreach, and/or online tools and resources. Round-the-clock phone access to registered nurses. Guidance and support from Nurse Coaches and other health professionals. Physician benefits: Save time for the physician and staff by answering patient questions and responding to concerns, freeing up valuable time for the physician and their staff. Support the physician-patient relationship by encouraging participants to follow their physician s treatment plan and recommendations. Inform the physician with updates and reports on the patient s progress in the program. Nurse coaches encourage participants to follow their physician s plan of care; not to offer separate medical advice. In order to help ensure that our service complements the physician s instructions, we collaborate with the treating physician to understand the member s plan of care and educate the member on options for their treatment plan. Providers are given a quarterly report for patients that are currently enrolled in the program including sharing the member s current educational goals. Please visit the anthem.com website to find more information about the program such as program guidelines, educational materials and other resources. Go to anthem.com and click on Providers. Select Virginia and click Enter. Go to Health and Wellness and then click on ConditionCare. Also on our website is the Patient Referral Form which you can use to refer other patients you feel may benefit from our program. If you have any questions or comments about the program, call Our nurses are available Monday-Friday, 8:30 a.m. to 9 p.m. CST, and Saturday, 9 a.m. to 7:30 p.m. CST. May of 34

10 We believe in continuous improvement Commitment to our members health and their satisfaction with the care and services they receive is the basis for the Anthem Blue Cross and Blue Shield Quality Improvement Program. Annually, Anthem prepares a quality program description that outlines the plan s clinical quality and service initiatives. We strive to support the patient-physician relationship, which ultimately drives all quality improvement. The goal is to maintain a well-integrated system that continuously identifies and acts upon opportunities for improved quality. An annual evaluation is also developed highlighting the outcomes of these initiatives. To see a summary of Anthem s quality program and most current outcomes, visit us at Case Management Program Managing illness can sometimes be a difficult thing to do. Knowing who to contact, what test results mean or how to get needed resources can be a bigger piece of a healthcare puzzle that for some, are frightening and complex issues to handle. Anthem is available to offer assistance in these difficult moments with our Case Management Program. Our case managers are part of an interdisciplinary team of clinicians and other resource professionals that are there to support members, families, primary care physicians and caregivers. The case management process utilizes experience and expertise of the care coordination team whose goal is to educate and empower our members to increase self management skills, understand their illness, and learn about care choices in order to access quality, efficient health care. Members or caregivers can refer themselves or family members by calling the number located in the grid below. They will be transferred to a team member based on the immediate need. Physicians can also refer by contacting us. No issue is too big or too small. We can help with transitions across level of care so that patients and caregivers are better prepared and informed about healthcare decisions and goals. How do you contact Case Management (CM)? CM Telephone Number CM Address CM Business Hours (Local/Commercial only) [email protected] Monday - Friday 8 a.m. 5 p.m. Medicare [email protected] Monday - Friday 8 a.m. 5 p.m. EST National [email protected] Monday - Friday 8 a.m. 5 p.m. May of 34

11 Clinical practice and preventive health guidelines available on the Web As part of our commitment to provide you with the latest clinical information and educational materials, we have adopted nationally recognized medical, behavioral health, and preventive health guidelines all available to providers on our website. The guidelines, which are used for our Quality programs, are based on reasonable, medical evidence, and are reviewed for content accuracy, current primary sources, the newest technological advances and recent medical research. All guidelines are reviewed annually, and updated as needed. The current guidelines are available on our website. To access the guidelines, go to the "Provider" home page at anthem.com. From there, select Provider and Virginia, then Health & Wellness> Practice Guidelines. Or, if you prefer, select the following link: f2/s2/t0/pw_a htm&state=va&rootlevel=1&label=practice%20guide lines Coordination of care Coordination of care among providers is a vital aspect of good treatment planning to ensure appropriate diagnosis, treatment and referral. Anthem Blue Cross and Blue Shield would like to take this opportunity to stress the importance of communicating with your patients other health care practitioners. This includes primary care physicians (PCPs) and medical specialists, as well as behavioral health practitioners. Coordination of care is especially important for patients with high utilization of general medical services and those referred to a behavioral health specialist by another health care practitioner. Anthem urges all practitioners to obtain the appropriate permission from these patients to coordinate care between Behavioral Health and other health care practitioners at the time treatment begins. We expect all health care practitioners to: 1. Discuss with the patient the importance of communicating with other treating practitioners. May of 34

12 2. Obtain a signed release from the patient and file a copy in the medical record. 3. Document in the medical record if the patient refuses to sign a release. 4. Document in the medical record if you request a consultation. 5. If you make a referral, transmit necessary information; and if you are furnishing a referral, report appropriate information back to the referring practitioner. 6. Document evidence of clinical feedback (i.e., consultation report) that includes, but is not limited to: Diagnosis Treatment plan Referrals Psychopharmacological medication (as applicable) In an effort to facilitate coordination of care, Anthem has several tools available on the provider website, including a Coordination of Care template and cover letters for both Behavioral Health and other health care practitioners.* In addition, there is a provider toolkit on the website with information about alcohol and other drugs that contains brochures, guidelines and patient information.** *Access to the forms and cover letters are available at anthem.com>providers>provider Home>Answers@Anthem **Access to the toolkit is available at anthem.com>providers>provider Home>Health and Wellness How to obtain language assistance Our members count on you. They may have questions, but language barriers prevent them from communicating. Anthem is committed to communicating with our members about their health plan, and our services, regardless of their language. Here s how your patients (our members) can receive help. Anthem employs a Language Line interpretation service for use by all of our Customer Service Call Centers. Members can simply call the Customer Service phone number on the back of their ID card and a representative will be able to assist them. Translation of written materials about benefits can also be requested by contacting customer service. TTY/TDD services also are available by dialing 711, or one of the numbers below. A special operator will contact Anthem to help with member needs (T) (V) May of 34

13 Important information about utilization management Our utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as the member s coverage according to their health plan. We do not reward providers or other individuals for issuing denials of coverage, service or care. Nor, do we make decisions about hiring, promoting, or terminating these individuals based on the idea or thought that they will deny benefits. In addition, we do not offer financial incentives for UM decision makers to encourage decisions resulting in underutilization. Anthem s Coverage and Clinical UM Guidelines are available on Anthem s website at anthem.com. You can also request a free copy of our UM criteria from our medical management department, and providers may discuss a UM denial decision with a physician reviewer by calling us toll-free at the numbers listed below. UM criteria are also available on our website. Just select Coverage & Clinical UM Guidelines, and Pre-Cert Requirements from the Provider home page at anthem.com. We work with providers to answer questions about the utilization management process and the authorization of care. Here s how the process works: Call us toll free from 8 a.m. - 5 p.m. Eastern. Monday through Friday (except on holidays). For Medicare, Monday through Friday from 8 a.m. 8 p.m. Eastern. After business hours, you can leave a confidential voic message. Please leave your contact information so one of our associates can return your call the next business day. Our associates will contact you about your UM inquiries during business hours, unless otherwise agreed upon. The following phone lines are for physicians and their staffs. Members should call the customer service number on their health plan ID card. To discuss UM Process and Authorizations Prompts 2,5,4,4,1 To Discuss Peer-to- Peer UM Denials w/physicians Prompts 2,5,4,4,1 To Request UM Criteria Prompts 2,5,4,4,1 TTY/TDD 711 or TTY: (T) Voice: (V) Behavioral Health: Behavioral Health: Behavioral Health: For Medicare: opt Fax Fax (for providers who previously used or ) May of 34

14 For language assistance, members can simply call the Customer Service phone number on the back of their ID card and a representative will be able to assist them. Our utilization management associates identify themselves to all callers by first name, title and our company name when making or returning calls. They can inform you about specific utilization management requirements, operational review procedures, and discuss utilization management decisions with you. Members rights and responsibilities The delivery of quality health care requires cooperation between patients, their providers and their health care benefit plans. One of the first steps is for patients and providers to understand their rights and responsibilities. Therefore, in line with our commitment to involve the health plan, participating practitioners and members in our system, Anthem Blue Cross and Blue Shield has adopted a Members Rights and Responsibilities statement. It can be found on our Web site. To access, go to the "Provider" home page at anthem.com. From there, select Provider and Virginia> then Health & Wellness> Quality > Member Rights & Responsibilities. Check the provider website regularly throughout the year for updates on pharmacy, and Clinical, Behavioral, and Preventive Health Guidelines. May of 34

15 Health care reform updates and notifications Breast pumps covered under preventive care benefits The preventive care provision of the Affordable Care Act (ACA) states that health plans must cover one breast pump per pregnancy with no cost sharing for female members. This benefit applies to nongrandfathered plans with renewals starting on or after August 1, Providers should note that not all policies include this expanded benefit, and effective dates may vary. Please continue to verify eligibility and benefits for breast pumps for all members. Frequently Asked Questions What is the preventive care benefit for breast pumps? The ACA expanded preventive benefit covers one breast pump at no cost sharing for female members any time during their pregnancy or following delivery when purchased from in-network providers. Where can Anthem Blue Cross and Blue Shield members purchase breast pumps covered under preventive care benefits? Members can buy or rent a breast pump from any in-network doctor or durable medical equipment (DME) supplier. In-network DME companies can be found by utilizing Anthem s online Provider Finder Tool. Will breast pumps be covered if purchased from retail stores? Retail stores such as Target or Wal-Mart are not DME companies, so breast pumps purchased from these types of stores are not covered. Some self-insured plans may grant exceptions to purchase breast pumps from retail stores. Members should confirm if their coverage includes this exception by contacting member services. Is a prescription or preauthorization required? When purchasing a breast pump through a participating DME supplier, a physician s prescription is required. The BCBSA Ancillary Claim Filing Guidelines require DME suppliers to include the ordering physician s NPI on the DME claim. Pre-authorization is not required. Are all breast pump models covered? Standard manual and electric breast pump models are covered for purchase at 100%, up to the amount of the contracted allowable rate. Hospital grade pumps are available as rentals when medically necessary and are covered up to the purchase price of the hospital grade breast pump. May of 34

16 Are breast pump supplies covered? Yes. Breast pump supplies are covered with no cost share for female members with the expanded benefit when purchased from an in-network doctor or durable medical equipment (DME) supplier. What billing requirements should be followed to submit claims for breast pumps? In-network doctors and DME providers should follow their normal billing processes outlined in their provider contract. Additionally, DME providers should refer to the recently published Ancillary Claim Filing Requirements, as mandated by the BCBSA. What process should be followed if a member wishes to purchase a non-standard or deluxe model breast pump? If a member wishes to purchase a non-standard or deluxe model breast pump that exceeds the reimbursement for the device that is considered medically necessary, providers may balance bill the member for the additional cost above the contracted rate by using the following billing process: Report the appropriate HCPCS code and charge for the standard model breast pump on the first line of the claim. Report code S1001 and the balance between the standard model and deluxe model on the second line of the claim. Prior to dispensing the breast pump, have a waiver signed by the member indicating that they are aware that the breast pump purchased is a deluxe model, and that the member is liable for the difference between the reimbursement rate for the standard model and the deluxe model charges. Site launched to educate on health care reform Anthem Blue Cross and Blue Shield recently launched an educational site about health care reform for members and consumers. The site is featured on anthem.com in a new area specifically for health care reform information. Health Care Reform 4 You provides simple, straight-forward information to help your patients understand how the health care reform law affects them. There are easy-to-use tools, such as a timeline of what to expect, and descriptions of important health care reform laws. Members can get a big picture view of heath care reform or learn greater detail about changes to health insurance benefits, such as pre-existing condition changes and the expansion of preventive care benefits. Health Care Reform 4 You offers even more personalized information to viewers when they answer a few simple questions. We understand that providers often encounter questions from patients about health care reform. We hope that you find this to be a valuable resource that can be shared with patients to obtain information about how health care reform impacts them. May of 34

17 ICD-10 update ICD-10 Tip: You don t have to learn the entire code set Picture this: This time next year, you are working with one of your patients to pre-authorize several tests and procedures to occur over the next few weeks. As you begin to schedule them, you realize the last procedure for which you need preauthorization will be after October 1, Having kept up with the ICD-10 updates from Anthem, you know that you can preauthorize this procedure. But you didn t get around to the coding training you d planned to take, figuring how hard could it be? So you pull out that brand new ICD-10 procedure reference for the first time and realize that there are now 12 ICD-10 codes for this procedure. Now you have to decide which code to choose. How? Pre-authorizing future procedures is an everyday occurrence in physicians offices. However, what was once a simple task can become a nightmare if you are not properly prepared for ICD-10. Depending on the size of your practice and the specialties of your physicians, there may be many more new codes you ll have to choose from for your most common procedures. Determining the correct codes now can save you a lot of guessing later. Target commonly used procedure and/or diagnosis codes So, as a strategy for how to begin learning ICD-10: 1. Target procedure and/or diagnosis codes you use most frequently and learn these codes first. 2. From there, build your knowledge of ICD-10 by including the codes you may not use as often. 3. Don t forget you ll also need to have your physicians provide thorough documentation in order for you to choose the correct codes for your claims. 4. Once you have your lists of codes, create quick reference documents so you don t have to pull out the coding books for codes you use every day. May of 34

18 These next few months will go quickly, and 2014 will be here before you know it. Don t get caught guessing. Choosing the wrong code for your claims could negatively affect your practice. However, being proactive by planning for the ICD-10 changes will be key to a smooth transition. Stay connected with us on ICD-10 by visiting the ICD-10 Updates webpage. Select HERE to view more. ebusiness Availity : Multi-payer portal If your day consists of juggling passwords, paperwork and phone calls from multiple health plans, including Anthem Blue Cross and Blue Shield, then you need to meet the new secret to your success. Availity offers a single, easy-to-use Web portal with a single sign-on providing you with access to the majority of health plans that reimburse your practice, including Anthem. The Availity portal is secure, easy to navigate and (best of all) real time with multiple health plans so you always have access to the most up-to-date information available including: Patient eligibility and benefits Claim status Care Profile Clinical Messaging Member Certificate Booklets Did we mention there s no charge? You pay absolutely nothing for the convenience of a consistent, secure online portal with real time health plan information from the health plans in your area. How to get started To register for access to Availity, go to It's that simple. Free Training Once you log into the secure portal, you'll have access to many resources to help jumpstart your learning, including free live training, frequently asked questions, and comprehensive help topics. To view the current training webinar schedule, click Free Training at the top of any page in the Availity portal or click to find a current schedule of FREE Availity workshops and webinars. Client service representatives are also available Monday through Friday to answer your questions at 800-AVAILITY ( ). Availity, an independent company, provides claims management services for Anthem Blue Cross and Blue Shield. May of 34

19 Sign up for alerts via Network eupdate Our provider newsletter, Network Update, is our primary source for providing important information to health care providers and professionals. Network Update is published bi-monthly and is posted to our website for easy 24/7 access. We also send a link to each newsletter via confidential s using our Network eupdate tool to all participating providers and professionals for whom we have an address on file. Reminder notifications sent via If you are NOT currently registered to receive an notification when each newsletter issue is posted online and would like to receive our Network eupdate, please sign up on our website just select Virginia and access the provider home page. There, you ll find a link to register for our Network eupdate. When you sign up, you ll not only receive an reminder for each newsletter posted online, you ll also be notified of other late breaking news and important information you ll need when providing services and filing claims for our members. It s easy to sign up. Just a few clicks, and you re done. Medicaid update Change to immunization administration for Medicaid HealthKeepers Inc. has been reimbursing $3.40 for the administration of immunizations provided to Medicaid members for non-vaccine for Children (VFC) vaccinations. To align with Medicaid policy, effective June 1, 2013, HealthKeepers Inc. will no longer reimburse for the administration of immunizations (codes , ) to a Medicaid member for non-vfc vaccinations. However, we will continue to reimburse for covered non-vfc biologics. There is no change to the administration of immunizations for VFC-eligible Medicaid members or FAMIS members. The administration continues to be reimbursable. May of 34

20 Medicare information Notice of Medicare non-coverage requirements The Centers for Medicare & Medicaid Services (CMS) requires providers to deliver a Notice of Medicare Non-Coverage (NOMNC) to every Medicare beneficiary at least two days prior to the end of their skilled nursing, home health or comprehensive outpatient rehabilitation facility (CORF) care. Additionally, CMS requires Medicare inpatients to receive written information about their discharge rights. CMS has defined how this Important Message from Medicare (IM) is to be delivered by facilities to Medicare beneficiaries. CMS requires 100 percent compliance. To help our providers meet these CMS requirements, Anthem periodically conducts IM/NOMNC audits annually and re-audits when needed to identify and recommend opportunities for improvement, and work with the provider to improve their process. Additional information can be found under Important Medicare Advantage Updates. Our recent audit findings of facilities show opportunities to improve in the following areas: Submitting Notice of Medicare Non-Coverage (NOMNC) and Important Message from Medicare (IM) notices no later than two days before the termination of services Verifying notices are signed and dated by the member Providing complete and accurate records/documentation during audit. Records requested during audit include NOMNC and IM notices, proof of discharge and admission dates. Anthem will continue to work with providers to reach the 100 percent compliance goal. Definitions NOMNC: Notice of Medicare Non-Coverage A Medicare health provider must give an advance, completed copy of the NOMNC to enrollees receiving skilled nursing, home health, or Comprehensive Outpatient Rehabilitation Facility services, no fewer than two days before the termination of services. The name, address, and telephone number of the provider delivering the notice to the enrollee must appear in the header of the NOMNC. The entity s registered logo is not required, but may be used. IM: Important Message from Medicare Hospitals must notify Medicare beneficiaries who are hospital inpatients about their hospital discharge appeal rights. Hospitals will use the IM notice to explain the beneficiary s rights as a hospital patient, including discharge appeal rights. Hospitals must issue the IM within two calendar days of admission, must obtain the signature of the beneficiary or his or her representative and provide a copy at that time. Hospitals will also deliver a copy of the signed notice as far in advance of discharge as possible, but not fewer than two calendar days before discharge. The notices are also available on at the Link for Hospital Discharge Appeal Notices. May of 34

21 For more information on compliance with the Notice of Medicare Non Coverage or the Important Message from Medicare, contact Patricia Casey, RN, at (858) Precertifications, observation and timely notification reminders for Medicare Advantage members Getting the best care in the most appropriate setting is key to achieving the best outcomes for our Medicare Advantage members. These members rely on their health care professionals and their health plan to help coordinate this important aspect of their care. To do this, timely requests for service and communication are essential. Please be aware of the following considerations and requirements to help ensure effective coordination of care for Anthem Medicare Advantage members and assure consistent application of the Centers for Medicare & Medicaid Services guidelines and MCG (formerly known as Millman) for pre- and post-service medical necessity and site-of-service reviews. Inpatient precertifications Hospitals are required to notify and/or obtain a prior authorization from Anthem as early as possible, but no later than within one business day of admission. The process for decision making is fastest when all supporting documentation accompanies the request for precertification. Hospital observation, inpatient admission and timely notification Please notify Anthem as soon as possible following admission but no later than within one business day of admission. If we don t receive notification of admission, a retrospective review for medical necessity and site of service will be conducted when the claim is submitted. MCG (formerly known as Millman) criteria will be applied when determining medical necessity for any requested in-patient stays. Following CMS and MCG criteria as well as the Anthem utilization management program will help ensure the appropriate clinical services are provided with the applicable member cost. Precertification for admission to skilled nursing facilities, long-term acute care hospital or acute rehabilitation center According to CMS guidelines, patients should be admitted to a skilled nursing facility when as a practical matter, considering economy and efficiency, the daily skilled services can be provided only on an inpatient basis in a SNF.* May of 34

22 Skilled Nursing, Acute Rehabilitation and Long Term Care facilities are required to obtain precertification for Medicare Advantage members before that member can be admitted. For the member to receive maximum benefits, the health plan must authorize or precertify the admission. To assure payment according to contract, before a Medicare Advantage member is transferred to the receiving facility, the facility must notify the plan and receive a precertification authorization for that transfer. Please note: Precertification includes a review of both the service and the setting. Please present the request for admission to a Skilled Nursing Facility, Acute Rehabilitation Facility, and/or Long Term Acute Care facility prior to admission. Please provide all supporting documentation with the request for precertification at the time of the request for admission. If the required precertification is not obtained prior to the service, the claim may be administratively denied for all days accrued prior to receiving an approval for admission, in accordance with your provider contract. To obtain precertification or to verify member eligibility, benefits and account information, please call the telephone number listed on the back of the member s identification card. Please refer to your provider agreement, provider manual and the Medicare Advantage Precertification Guidelines found at the Medical Policy, UM Guidelines and Precertification Requirements link on the Anthem provider home page for further information on precertification and precertification requirements. Questions from hospitals and acute care facilities should be directed to your network representative. For skilled nursing facility questions, please call (804) Please share this information with clinical staff and others involved with facility authorization and admissions. We look forward to working with you and your colleagues to ensure our members are discharged at the right time clinically, to the right place and achieve the best clinical outcome. * Medicare Benefit Policy Manual Chapter 8 - Coverage of Extended Care (SNF) Services Under Hospital Insurance (Rev. 155, ) Medicare Advantage members receive personalized checklist for preventive services We encourage Medicare Advantage members to see their physician for the Annual Wellness Visit and other preventive services. Earlier this year, Medicare Advantage members received a Healthy Checklist from us that reminds members to ask you about preventive care and screenings they may need. Members may bring the checklist to their office visits. Please review the checklist with them to help ensure they understand and receive any preventive care or screenings they may need. May of 34

23 SilverSneakers Fitness Program helps older members stay active One of the best ways for older adults to stay in control of their health is to be physically active. Anthem encourages members to be active by offering them the SilverSneakers Fitness Program, one of the nation s leading exercise programs designed exclusively for older adults, at no cost beyond their monthly plan premium. It s easy for members to begin using the SilverSneakers benefit. Members may call , seven days a week, 8 a.m.-8 p.m. (TTY/TDD users should call ) or visit for details. Anthem took action to spread the word about increased flu activity This year s flu season caused more than average counts of hospitalizations and death as the number of cases peaked to high levels in several states across the US. In mid January, the Centers for Disease Control and Prevention (CDC) reported that 30 states were experiencing high levels of flu-like illnesses and all but 2 of the 50 states reported flu activity across more than 50 percent of its geographical region.* Because this season s flu activity was higher than expected and the proportion of deaths attributed to pneumonia and influenza was above the epidemic threshold, Anthem took the initiative to spread the word. * In response to this increased activity, all Medicare Advantage members residing in a CDC designated high activity state received an Interactive Voice Response (IVR) call alerting them of their increased risk. The purpose of the call was to increase awareness, encourage vaccination for those who had still not gotten their flu shot, and to recommend members contact their primary care doctor for severe flu-like symptoms. This call campaign targeted 156,000 members in eight states (MO, VA, GA, CO, NH, NY, CT, IN) to receive messaging to reinforce CDC s recommendations for protection and prevention -- the best defense being to get vaccinated. *Centers for Disease Control and Prevention: Flu View: Influenza Season Week 2 Ending January 12, 2013, Annual medical chart review program for Medicare Advantage members under way Each year, Anthem requests your assistance in our retrospective medical chart review program. This program, which includes a request for our Medicare Advantage members medical charts for 2011 dates of service, is a vital part of Anthem s compliance with CMS guidance that requires Medicare Advantage health plans to collect and report to CMS all member diagnoses data. CMS requires that this data be supported by the member s medical record documentation. May of 34

24 To assist with our medical chart review program, Anthem will again be collaborating with MediConnect Global, Inc. (MediConnect), a leading records retrieval and electronic document management company that specializes in medical records retrieval, coding and delivery via the internet. MediConnect s web based workflows will help reduce time and improve efficiency and costs associated with record retrieval, coding, and document management. Anthem will be working with MediConnect in retrieving and reviewing our Medicare Advantage member medical records. The request for medical records will begin in May and will continue throughout the year. As the physician for our Medicare Advantage members, you play a critical role in the success of this program and our compliance with CMS requirements. By maintaining quality coding and documentation practices and by cooperating with our medical chart requests, you will be instrumental in helping Anthem meet its CMS obligations and will help ensure risk adjustment payment integrity and accuracy House Call Program for Medicare Advantage members launches Anthem announces the launch of its 2013 House Call Program. The House Call Program is a voluntary program and provides our Medicare Advantage members with the opportunity to receive a health evaluation in the comfort of their own home. The House Call Program was developed to help enhance and support the care currently provided to the member. Information collected during the evaluation helps us identify members who may benefit from case management programs and helps the member s physician match healthcare needs with the appropriate level of care. And finally, the program helps Anthem meet its CMS obligations for reporting all required diagnoses to CMS for each member on an annual basis for the purpose of risk adjustment. Anthem begins the program by mailing a letter to our members that describes the program. The letter is then followed by a phone call to schedule an appointment for the health evaluation. The program is free to the member and entirely voluntary. Health evaluations are conducted by licensed and credentialed providers who are working with a vendor with whom Anthem contracted to perform these services on our behalf. As part of the visit, the clinician will document all medical conditions that exist on the date of visit on a health evaluation form. Anthem will make a copy of the completed health evaluation forms available to the member s physician for his or her records. In addition, based on the outcome of the health evaluation, Anthem may conduct post-visit outreach with the member s physician and may make a case management referral. Y0071_13_16967_I 03/28/2013 May of 34

25 Global surgical modifiers on Medicare Advantage claims Anthem Blue Cross Blue Shield has identified a need to educate providers on the appropriate billing for global surgical procedures when one physician performs the surgery and another, who is not a member of the same group, performs the postoperative care. Claims should be submitted with modifier 54 when the surgeon performs the surgery and relinquishes all or part of the postoperative care to a physician who is not a member of the same group. The global surgical procedure performed, with either 10- or 90-day postoperative care period, should be appended with the modifier 54. The physician performing the postoperative care should bill with modifier 55 with the date of surgery as the date of service. The date postoperative care was assumed (relinquished by the surgeon) must be in Field 19 of the CMS-1500 claim form or the electronic equivalent. The assumed and relinquished care dates are required in order to properly reimburse the correct number of postoperative days. The physician rendering the postoperative care must coordinate billing with the surgeon to assure that the surgeon bills their claim with the 54 modifier. Modifier 56 would only be used when a physician performed the preoperative care and another physician performed the surgical procedure. The preoperative component may be identified by adding the modifier 56 to the surgery procedure code. Note the 56 modifier is not valid to bill for Medicare claims. Y0071_13_16901_I_002 May of 34

26 Pharmacy update Pharmacy information available on anthem.com Visit for more information on pharmacy copayment/ coinsurance requirements and their applicable drug classes, Drug Lists and prior authorization criteria, procedures for generic substitution, therapeutic interchange, step therapy or other management methods subject to prescribing decisions, and any other requirements, restrictions, or limitations that apply to using certain drugs. For Anthem HealthKeepers Plus [state-sponsored business (SSB)/Medicaid], visit Medicaid Pharmacy Information. Bulletin board Medical office seminars and webinars on tap Please consider attending one of our informative webinars or in-person seminars based on your schedule. While we no longer offer in-person seminars in the central region of the state, we ve added two more online webinars for your convenience. We continue to offer in-person seminars on a limited basis in the eastern, northern and western regions of Virginia. As a reminder, our provider training opportunities are available only to Anthem-contracting professional providers and their staffs. These informative sessions are offered at no charge as a benefit of network participation. Professional providers, defined as those who submit claims using the 837P (electronic) or CMS-1500 (paper) claims format, include the following practitioners and their office staff: MDs, DOs, DPMs, DCs, LCPs, LPCs, LCSWs, LFMTs, CNSs, CNMs, plus DDSs and DMDs (for non-routine medical dental services), and optometrists (ODs) and opticians (for non-routine medical vision services) rendered to Anthem members. In-person seminars are held in the eastern, northern and western parts of the state; online LiveMeeting webinars are accessible by providers statewide. Due to the wide range of medical specialties represented by the above professional May of 34

27 providers, we cannot target information specific to each, so we take a more global approach in the covered material to afford useful information for all. Additionally, practitioners with other than the credentials shown above should contact their local Anthem network manager to learn of training opportunities that may be available for their respective specialties. Please make plans now to attend a seminar that will be offered in your region of Virginia eastern, northern or western, and/or a webinar that can be conveniently accessed from anywhere in the Anthem (Virginia) service area via your office computer and telephone. Seminar topics The following topics may be included in each regular three-hour seminar or the condensed one hour quarterly webinar. Additional topics of local interest not listed here may also be included. NOTE: Due to the expansion of our HMO plans (HealthKeepers and HealthKeepers Plus) in southwest Virginia, you will notice seminars labeled as HMO Expansion. These seminars will contain information specific to our HMO procedures only. Claims filing for professional providers with emphasis on the 837P professional electronic claim transactions, and other e-transactions. Use of e-tools found on our open Web portal at anthem.com, as well as our secure portal, Point of Care, plus information regarding Availity. New product and/or benefit changes for our PAR, PPO, HMO, Medicaid HMO and Medicare Advantage plans. Updates for state (Commonwealth of Virginia), local (The Local Choice), and federal (Blue Cross and Blue Shield Service Benefit Plan or FEP) government programs. The BlueCard Program (out-of-area program) from the national Blue Cross and Blue Shield Association. Medical Management; Utilization Management; Pharmacy Management And/or other topics of timely importance Certificate of completion Those who complete an in-person seminar will receive an Anthem Certificate of Completion for submission to various professional organizations for possible continuing education credit. Additionally, we have received CEU approval from the American Academy of Professional Coders (AAPC) for both our in-person seminars and online webinars this year. The program instructor will supply information to participants at the time of these sessions. May of 34

28 Registration/cancellation Reservations are required as seminar seating is limited; webinar dial-in capacity is also limited. We will contact you if your session has already reached capacity or is being cancelled due to low registration. Please include your address, business telephone and fax numbers. Submit your completed registration form by FAX or mail (not both) as follows: For EASTERN Region Seminars ONLY o FAX: or o MAIL: Anthem Blue Cross and Blue Shield Attn: EASTERN Medical Office Seminars Mail Drop VAV101-A Bendix Road, Suite 100 Virginia Beach, VA For NORTHERN and WESTERN Region Seminars ONLY o FAX: or o MAIL: Anthem Blue Cross and Blue Shield Attn: NORTHERN and WESTERN Medical Office Seminars Mail Drop VACH01-A Concorde Parkway, Suite 2000 Chantilly, VA For WEBINAR REGISTRATION ONLY (Regardless of your location) o FAX: NOTE: If you must cancel after registering, please give us the courtesy of a call with at least 24 hours notice, or as soon as possible: o for WEBINARS, call o for EASTERN seminars, call o for NORTHERN and WESTERN seminars, call May of 34

29 2013 Medical Office Seminar Schedule REGION TYPE DATE and TIME LOCATION WESTERN HMO Expansion May seminar postponed. New date to come. Bristol Regional Medical Center Room TBA 1 Medical Park Boulevard BRISTOL, TN NORTHERN Regular September (Date TBA) 10 a.m. 1 p.m. EASTERN Regular Thursday, May 16 1 p.m. 4 p.m. EASTERN Regular Thursday, October 24 1 p.m. 4 p.m. EASTERN Regular Thursday, November 7 1 p.m. 4 p.m. Prince William Hospital 4 th Floor - Conference Room TBA 8700 Sudley Road MANASSAS, VA Anthem Blue Cross and Blue Shield Convergence Center II - Hampton Roads Room 277 Bendix Road, Suite 100 VIRGINIA BEACH, VA Riverside Conference Center Bldg. 6, Suite 6B Warwick Boulevard NEWPORT NEWS, VA Anthem Blue Cross and Blue Shield Convergence Center II - Hampton Roads Room 277 Bendix Road, Suite 100 VIRGINIA BEACH, VA NOTE: TBA = To be announced. Please be aware that due to the continuing HMO Expansion in Southwest Virginia, additional dates / locations may still be added. If this occurs, these additions will appear in future editions of the Network Update. Additionally, the CENTRAL region in Virginia will not have in-person seminars this year, but participants will be invited to register to attend our LiveMeeting webinar(s). ADDITIONAL TIPS: We highly recommend attendees bring a sweater or jacket for personal comfort. Beverages/snacks will be provided at all seminars or you may brown bag your meal. Please ensure you submit your registration to the correct fax number that corresponds with your region. Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are 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. May of 34

30 2013 Medical Office Seminar REGISTRATION FORM Complete entire form; then FAX as follows: EASTERN REGION NORTHERN REGION WESTERN REGION IMPORTANT! Please read and complete the information below. Remember that faxes often lose quality in transit, so please print legibly. These FREE seminars are for network-participating physicians (MDs, DOs and DPMs), as well as Behavioral Health providers (MDs, PhDs, LPCs, LCPs, LCSWs, MFTs, and CNSs), doctors of chiropractic (DCs), certified nurse midwives (CNMs), dental/oral surgery providers of medical (non-routine) services, and optometrists (ODs) and opticians for medical (non-routine) services rendered to Anthem members, and their office personnel. Each 2013 Medical Office Seminar will contain current updates on a variety of topics as described online at under Provider Seminars or in the seminar article featured in each issue of the bi-monthly provider newsletter, Network Update. An Anthem Certificate of Completion will be given to attendees at the conclusion of each seminar for submission to various professional organizations for possible CEU credit. Additionally, we anticipate CEU approval from the AAPC for Certified Professional Coders (CPCs). For seating purposes, reservations are required; seating is on a first-come, first-served basis. If you register and then need to cancel, please give us 24 hours or as much notice as possible by calling as follows: for Peninsula and Tidewater (Eastern), call ; for Northern and Western call For personal comfort, we highly recommend attendees bring a sweater or jacket. Beverages/snacks will be provided at all seminars; you may also brown bag. If a hospital is providing lunch, this will be specified on the schedule. Seminar Date/Time and Location Attendee #1 Attendee #2 Provider Name Provider Specialty NPI # (individual) or NPI # (group) Provider Address with City /State /Zip Phone Number Fax Number Address Provider Website (if applicable) CONFIRMATION of your registration or notification that your seminar selection is full or has been cancelled will be sent to you via or FAX. Therefore, it is critical that you include your , phone, and fax numbers (including area code) when completing this form. THANK YOU. Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are 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. May of 34

31 2013 Medical Office Webinar REGISTRATION FORM These free Webinars are made available to Anthem network-participating providers and their office staff who are considered professional (non-institutional) providers, defined as those who submit claims using the 837P/CMS-1500 format. For purposes of these webinars, we include the following provider types: Physicians (MD, DO, DPM), Behavioral Health (MD, PhD, LPC, LCP, LCSW, LMFT, CNS), Doctors of Chiropractic (DC), Certified Nurse Midwives (CNM), Dentists/Oral Surgeons (DDS, DMD), and Optometrists (OD) and Opticians (For dental and vision, rendering medical (non-routine) services). Webinar attendees must have Internet capability with simultaneous telephone access. Provider Request for Anthem WEBINAR Invitation Provider/Practice Name: Medical Specialty: Provider Type: NPI #: Tax ID #: *Attendee Name: * Address: Phone #: Fax #: Practice Website: *NOTE: If multiple attendees will be viewing the webinar and listening together as a group via a single computer and phone line, we only need one address but all attendees names. However, if multiple attendees will each be viewing and listening from their own work stations, we must have SEPARATE registration forms with each individual s name and address. Please mark which WEBINAR(s) you wish to attend: Wednesday, June 26, Wednesday, September 25, Wednesday, December 18, (10:30a.m. 11:30a.m.) 2Q13 Anthem Updates (10:30a.m. 11:30a.m.) 3Q13 Anthem Updates (10:30a.m. 11:30a.m.) 4Q13 Anthem Updates PLEASE COMPLETE THIS FORM AND FAX TO An containing the LiveMeeting link and the telephone numbers for dialing in will be sent to official registrants only; therefore, please register at least one week prior to the webinar to ensure timely receipt of this information. THANK YOU. Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are 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. May of 34

32 2013 Medical Office Webinar Schedule REGION TYPE DATE and TIME LOCATION STATEWIDE General Topics Wednesday June 26 10:30 a.m. 11:30 a.m. Your computer and phone via LiveMeeting STATEWIDE General Topics Wednesday September 25 10:30 a.m. 11:30 a.m. Your computer and phone via LiveMeeting STATEWIDE General Topics Wednesday December 18 10:30 a.m. 11:30 a.m. Your computer and phone via LiveMeeting Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. are 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. May of 34

33 2013 Community involvement and events Improving the health of the communities we serve is at the heart of everything we do. It s why we develop events like those outlined below that help people get engaged with a healthy lifestyle while also creating opportunities to raise money for important causes such as efforts to fight heart disease and cancer. We hope you find this information of interest and will share with your patients as you deem appropriate Schedule of Events Event Overview More Information Anthem LemonAid July Richmond/Tidewater Anthem LemonAid is an opportunity for families to be part of helping to fight pediatric cancer. Visit our web site at or call Supports: Children s Hospital of Richmond and Children s Hospital of The King s Daughters Anthem Moonlight Ride August 17 Richmond Fab 5k at Roanoke County s Green Hill Park August 17 Roanoke Heart Walks September 21/Richmond October 12/Newport News September 21/Norfolk October 1/Roanoke Anthem Great Pumpkin October 12 Reston Anthem Blue Cross and Blue Shield Presents Go Outside Festival October Roanoke Celebrate the joy of cycling at the annual Anthem Moonlight Ride. For those new to fitness walks, this one is perfect with one of the flattest courses in Virginia. Plus, this event includes a cash prize for top finishers. Help save lives by joining us for this annual walk that benefits the American Heart Association s research to fight heart disease. Bring the family out for our annual Anthem Great Pumpkin 5k. By combining the things outdoor enthusiasts love camping, music, movies, gear, races, and demos the Go Outside Festival is a celebration of everything outdoors. Visit onlight_ride.htm to learn more. Supports: Fit4Kids Visit for more information. Visit for more information. Supports: American Heart Association Learn more at May of 34

34 Anthem Into the Darkness Night Trail Run at Virginia s Explore Park October 19 Roanoke Anthem Wicked 10K October 26 Virginia Beach Call Federal Credit Union Marathon October 26 Richmond Anthem Richmond Marathon November 16 Richmond Enjoy Roanoke Valley s only night time trail run at Virginia s Explore Park. This 4-mile event is perfect for the entire family. Easily the largest outdoor Halloween costume party in Virginia Beach. Complete the race in any pace, with prizes for the best costumes. As part of the Anthem Richmond Marathon, kids can get a head start on the fun by coming out for this junior marathon occurring two weeks prior. The event is open to kids between the ages of 4-14 and participants can elect to participate in 0.5 mile, 1-mile or 2-mile race, based on age and ability. Enjoy a great scenic course that takes you through some of Richmond's most historic neighborhoods, culminating with a downhill finish on the city s beautiful riverfront. Registrants can choose from the full 26.2 mile course or opt for either the half marathon or 8k course. To get more information, visit Visit for more information. Register at: Learn more by visiting The information in this publication is for informational purposes only and should not be construed as treatment protocols, required practice guidelines or product endorsement. Diagnosis, treatment recommendations, and the provision of medical care services for Anthem members and enrollees are the responsibility of providers and practitioners. May of 34