Your Guide to Anthem HealthKeepers Plus Web Updates and Other Changes

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1 Your Guide to Anthem HealthKeepers Plus Web Updates and Other Changes Effective November 1, 2013, we have made some great changes to our provider website and a few of our tools. Recently, we announced that our company is consolidating claims and membership systems to a common platform for our members enrolled in Anthem HealthKeepers Plus for both Medallion II (Medicaid) and Family Access to Medical Insurance Security (FAMIS) plans. This transition impacts remittance vouchers, prior authorization requirements and reimbursement policies. These changes are designed to assist you in serving our members enrolled in Anthem HealthKeepers Plus who are your patients. Our top priority is making sure you have everything you need to seamlessly serve your Anthem HealthKeepers Plus patients, and this guide will provide information on what you ll need to know to make the transition easy for you. By going to the same anthem.com Point of Care web-based provider tool you already use, you will see a new link named Anthem Virginia Medicaid. The new Anthem Virginia Medicaid website has special tools and features and will be your one-stop shop to submit claims, verify member eligibility, download your panel listings, look up prior authorization requirements and more! One key thing to remember is that Anthem HealthKeepers Plus members benefits are not changing. However, some of our service partners are different. Refer to our Key Contacts section for complete information about how to contact Anthem HealthKeepers Plus and our service partners. We look forward to working with you to make a difference in the lives and quality of health care for our members your patients. Keep reading to find out about enhancements to our website and the exciting changes we ve prepared for you. In This Guide: The New Anthem Virginia Medicaid Website... 2 Web Features... 3 Your Remittance Advice/Voucher... 5 Member Identification Cards... 7 Serving Our Members Your Patients... 8 Opting In to Paper Member Panel Listings... 8 HealthKeepers, Inc. Key Contacts... 8 Service Partners Key Contacts... 9 A new way of getting the information you need! Frequently Asked Questions Have more questions? HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. VAW /01/13 AVAPEC

2 Page 2 of 11 The New Anthem Virginia Medicaid Website Effective November 1, 2013, HealthKeepers, Inc. is making available to you, from Point of Care, a new Anthem Virginia Medicaid website: Although you can continue to use Point of Care as you always have, the Anthem Virginia Medicaid website is where you can verify membership and benefits and obtain authorizations for Medicaid members. Here s a sneak preview of how the Anthem Virginia Medicaid website will look. Actual content may vary. SAMPLE CONTENT Please Note: To obtain prior authorization for advanced radiology services for our members enrolled in Anthem HealthKeepers Plus, contact American Imaging Management.

3 Web Features Anthem HealthKeepers Plus Page 3 of 11 You will still go to Point of Care as you have in the past. In addition, our new Anthem Virginia Medicaid website offers new tools to help you manage claims online. The table below gives you an idea of some of the great new features and tools that will make it easier for you to serve our members. Claim Submission Checking Claims Status Claim Appeals Web Function What will be Different as of November 1, 2013? Online Correspondence Eligibility Lookup Authorization Submission Authorization Inquiry and Update Providers will now be able to file a single claim directly to the Anthem Virginia Medicaid website. And there will still be the option to submit batch claims, as in the past. Providers can still check claims status online. The claims status report will look different than it has in the past. Providers will be able to appeal a claim online and can now include attachments (up to 25 megabytes [MB]). Responses to provider online correspondence will now be given via phone call, or fax; providers will no longer receive responses via Point of Care. Providers will still have access to an Eligibility Lookup tool; however, it will be in a different format. Authorization requests can be submitted through the Anthem Virginia Medicaid website. There are some exceptions, including high-tech imaging, which goes through AIM. AIM s website: All inquiries and updates will be made through the Anthem Virginia Medicaid website.

4 Page 4 of 11 Updates to Service Request Procedures We want to update you on some new information: Notification of inpatient admissions submitted via the Anthem Virginia Medicaid website will now accept document attachments up to 25 MB of supporting member clinical information. This process replaces the need to fill in specific member clinical information via online forms. The clinical nurse reviews the request and will verify that the request meets criteria. You will receive a response by phone or fax within one business day. Notification of admission for vaginal and c-section deliveries submitted via the Anthem Virginia Medicaid website will continue to provide immediate authorization within two and four days respectively. Clinical documentation to justify extended lengths of stay can be attached to the notification, submitted online or faxed to a clinical reviewer at For high-tech radiology: Moving forward, you will obtain prior authorization from our radiology partner, American Imaging Management (AIM), using AIM s web portal. You also may call AIM toll free at Hours are 9 a.m. to 6 p.m. Eastern time, Monday through Friday. AIM s offices are closed Saturday and Sunday. Medicaid Reimbursement Policy All reimbursement policies will be replaced by those listed at Reimbursement policies are subject to change as necessary from time to time; however, we will provide 30 days prior notice before implementing any revisions.

5 Page 5 of 11 Your Remittance Advice/Voucher Here is a sample of how your new remittance advice/voucher cover page will look for Anthem HealthKeepers Plus, effective November 1, Please Note: For more information regarding descriptions of the codes used on the remittance advice/voucher, please go to the Anthem Virginia Medicaid website.

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7 Page 7 of 11 Member Identification Cards We have a new look to our member identification (ID) cards that will only affect your new Medicaid and FAMIS members. New cards will be issued to any new members who enroll after November 1, Below are examples of the new cards for the Medicaid and FAMIS programs. Please note that copayments for FAMIS members may be different than those depicted below. Medicaid: FAMIS Back Front Back Front Special notes: You can identify Medicaid members by the first three characters of the member ID number (YTD, YTE, YTF), or if the card has a Medicaid ID number. Address information for claims filing remains the same: P.O. Box Richmond, VA The HealthKeepers, Inc. address is now our Richmond mailing address: P.O. Box Mail Drop VA2002-N500 Richmond, VA 23279

8 Serving Our Members Your Patients Prior Authorization Requirements Anthem HealthKeepers Plus Page 8 of 11 Effective November 1, 2013, HealthKeepers, Inc. will be updating the list of codes relating to services that require Prior Authorization (PA) before they can be rendered to our Anthem HealthKeepers Plus members enrolled in the Medicaid or FAMIS plans. The following service categories are affected by this update: High-Tech Radiology Pain Management Injections and Procedures Prosthetic/Orthotic Devices Sleep Studies Tonsillectomy and Adenoidectomy Obstetrical Notification Coverage Guidelines You must notify HealthKeepers, Inc. as follows: At the first prenatal visit Within 24 hours of delivery with newborn information. Please include: o Baby s date of birth o Disposition at birth o Gender o Weight in grams o Gestational age Opting In to Paper Member Panel Listings Beginning on November 1, 2013, as a provider in the Anthem HealthKeepers Plus network, you may go to for easy access to your member panels. You will no longer automatically receive paper copies of your member panels. If you still require a printed copy of your member panels, call HealthKeepers, Inc. Key Contacts Use this table as your handy reference for key contacts within HealthKeepers, Inc. for Anthem HealthKeepers Plus prior to November 1, Effective November 1, 2013, we will have one centralized, easy-to-use number for all of your questions or concerns: To Contact Current Contact 24/7 Nurse Help Line TDD: Behavioral Health New Baby, New Life Prior Authorization: Local Richmond calling area Prior Authorization: Toll-Free Medicaid Inpatient: Ext

9 To Contact Current Contact Medicaid Outpatient: Ext Anthem HealthKeepers Plus Page 9 of 11 Provider / Member Services Outside the Tidewater Area: Provider and member services for Anthem Virginia Medicaid. Within the Tidewater Area: Member Services Center TDD line for members who are deaf or hard of hearing Service Partners Key Contacts This table provides the contact information for all of our service partners. To Contact Current Contact American Imaging Management (AIM) Radiology Website: American Specialty Health (ASH) Chiropractic benefit Website: Davis Vision Website: EDI Hotline a.m. to 8 p.m. Eastern time, Monday through Friday LabCorp Website: LogistiCare Website: Pharmacy: Express Scripts, Inc. (ESI) Home Delivery Service Help Desk Number Pharmacy: ESI Pharmacy: ESI Website Help Desk

10 A new way of getting the information you need! Anthem HealthKeepers Plus Page 10 of 11 Our new centralized phone number can make it easy for you to call for Anthem HealthKeepers Plus information. Here are the options to choose from when you call us at : From the main menu, you can now access the following: ENROLLMENT STATUS CLAIMS STATUS PRECERTIFICATIONS You can also say: o Case Management o Pharmacy o Mental Health o Substance Abuse o Website Support Our trained staff is ready to assist you! Frequently Asked Questions What is changing? Effective November 1, 2013, HealthKeepers, Inc. s Anthem HealthKeepers Plus Medicaid/FAMIS business is transitioning to a common platform for membership and claims processing. What will I, or my office staff, need to do for this change? You will still use our web-based provider tool Point of Care as you have in the past. Effective November 1, 2013, you may also use the new Anthem Virginia Medicaid website as a source of information for verifying membership eligibility, benefits, obtaining authorizations, etc. You will find a link to the new Anthem Virginia Medicaid website on Point of Care. There also may be different phone numbers for you to call for various functions. Will I still be able to use the anthem.com Point of Care website? Yes, you may still use the Point of Care website, just as you have in the past. Go to > Providers > In the To Enter Site, Click Here drop-down menu, select Virginia. You will see a new link named Anthem Virginia Medicaid Information. Are the new reimbursement policies posted on anthem.com? The new reimbursement policies will be posted by October 15, Check back often to see if the policies are available online. Will I still file claims to the same place? Yes, you will still file claims to the same place.

11 Page 11 of 11 Will claims process exactly the same way after the internal system conversion effective November 1, 2013? Yes; after the conversion, claims will process the same way. During the conversion, there will be a small number of claims which span the November 1, 2013, transition date. On November 1, 2013, we will automatically route your claim to the correct system based on the date of service. Depending upon the claim type, we may process a portion of the claim in one system and the other portion in our new processing system. As a result, you will receive two remittances. In these rare instances, you will receive a letter notifying you of the two payments with the claim detail and check numbers to aid you in reconciling your records. What electronic vendors will be used? We are working on a specific list, so please check back with us later. Where can I access remittance information? You can access remittance information on the Point of Care website. Will I receive remittances on the same remittance voucher as other Anthem business? No, there will be a separate remittance voucher. Refer to the Your Remittance Advice/Voucher section in this guide for information about the new remittance voucher. Will I still be able to perform labs on the current Provider Office Lab List and be paid feefor-service? Yes, this scenario will remain the same. Will I still have Medicaid members included in Anthem Quality Insights (AQI )? No, Medicaid will be amended out of AQI for 2014 and forward. If I have claims processing or member eligibility issues, what number should I call? Call the following numbers with questions about claims or member eligibility: Tidewater Area Member and Provider Services Use this number until October 31, Outside Tidewater Area Member and Provider Services (Virginia Medicaid Only). Have more questions? As always, we appreciate the care and service you give to our Anthem HealthKeepers Plus members who are your patients. Thank you for continuing to verify member eligibility to ensure a smooth claim submission process and reduce the risk of denied claims. We hope the changes we made to the Anthem Virginia Medicaid website and other updates explained in this guide will help you use these tools and make it easier for you to care for our members your patients. If you have questions about the information in this guide or need help, call or contact your network manager.