Provider Additions and Maintenance

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1 Working with Anthem Subject Specific Webinar Series Provider Additions and Maintenance Access to Audio Portion of Conference: Dial-In Number: Conference Code: # Please Mute Your Phone 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.

2 Agenda Housekeeping & Announcements Provider Additions and Maintenance New Providers o Credentialing requirements o Wisconsin Autism mandate Credentialing application o Council for Affordable Quality Healthcare (CAQH) Online Provider Maintenance Form (PMF) walk through Approval notification 2

3 Agenda - continued Provider changes and terminations Tax identification number changes Links and handouts Questions and Answers 3

4 Navigation and Handouts Click here for handouts 1. Select items by checking the boxes 2. Select a destination on your computer 3. Press OK to download Control your view Full Screen 4

5 New Providers Providers requiring credentialing - Medical Facilities o Acute Care Hospital, Ambulatory Surgery Center, Skilled Nursing Facility Professional o MD, DO, Pain Management, Chiropractors, Oral Maxillofacial Surgeon - MD's & DDS's practicing as OMS, Medical Therapists (e.g. physical therapists, speech therapists and occupational therapists) and other individual health care practitioners listed by name in Anthem s Network directories require credentialing. 5

6 New Providers Providers exempt from credentialing - Medical Facilities o Dialysis Center, Hospice Professional o Anesthesiology, Emergency Medicine, Hospitalist, Nurse Practitioner, Pathology, Physician Assistant, Radiology 6

7 New Providers Providers requiring credentialing Behavioral Health Facilities o Acute Care, Inpatient, Intensive Outpatient, Residential Treatment Professional o Psychiatrist (MD), Psychologist (PhD, PsyD, EdD), Licensed Clinical Social Workers, Licensed Professional Counselors, Licensed Marriage and Family Therapist, Advanced Practice Nurse Prescribers (APNP) 7

8 New Providers Providers exempt from credentialing Behavioral Health Professional o Substance Abuse Counselor (SAC) o Clinical Substance Abuse Counselor (CSAC) Note: Certified Alcohol and Drug Counselor I, II, and III (CADC I, CADC II, and CADC III) are now Substance Abuse Counselor (SAC) 8

9 New Providers Wisconsin Autism Mandate State Statute (12m) and Senate Bill 667 Requires coverage for evidence-based therapy services for individuals with Autism Spectrum disorders provided by qualified providers. Certification forms required in addition to credentialing for providers delivering therapy services. Certification forms available under Behavioral Health Provider Resources under Self Service and Support on the Provider Home page. 9

10 New Providers Wisconsin Autism Mandate State Statute (12m) and Senate Bill 667 continued Qualified specialty specific provider certification forms o o o o o Psychiatrist, Psychologist, Behavioral Analyst or Licensed Social Worker Certification form for Intensive Level Services Psychiatrist, Psychologist, Behavioral Analyst or Licensed Social Worker Certification form for Non-Intensive Level Services Outpatient Mental Health Clinic Certification Form Autism Paraprofessional Certification Form (completed by supervising provider) Occupational Therapist and Speech Therapist Certification Form 10 10

11 New Providers Credentialing application Council for Affordable Quality HealthCare (CAQH ) Required submission through CAQH ProView Meets URAC and NCQA data collection standards Enter data once for all national Health Plans Practice Mangers Module No cost to providers CAQH ProView Support Desk: or CAQH. All Rights Reserved CAQH, a non-profit alliance, is the leader in creating shared initiatives to streamline the business of healthcare. Through collaboration and innovation, CAQH accelerates the transformation of business processes, delivering value to providers, patients and health plans

12 New Providers Credentialing application Approval Authorize release of information to Anthem Attested and Complete by CAQH Online Provider Maintenance Form (PMF) Submission Source Verification Anthem Anthem Credentialing Committee Approval o Anthem Credentialing Process Information Wisconsin Provider Manual - June

13 New Providers Online Provider Maintenance Form (PMF) Available on the Provider Home page under Self Service and Support and under Provider Forms Also available on Availity under Payer Resources, Anthem Electronic routing to Anthem in Wisconsin PMF section walk-through Handout: Provider Additions and Maintenance Reference Tool 13 13

14 Online Provider Maintenance Form (PMF) - Entrance Welcome Medicaid Question 14 14

15 Online Provider Maintenance Form (PMF) Section A General Information Pertains to Group information only Practice Tax Identification Number (EIN/SSN) Wisconsin Provider Id Number - If you do not know your 12-digit Anthem Provider Identification Number (PIN), please enter twelve (12) nines in this field. Group Practice National Provider Identification (NPI) Number If Group Practice, # of physicians in practice - This is intended to be the number of practitioners that submission pertains to and usually equals one

16 Online Provider Maintenance Form (PMF) Section B Reason for submission Effective Date Requires 30 days prior notification Adding a provider vs. Adding a provider to a location Deleting a provider Supply a reason for deletion 16 16

17 Online Provider Maintenance Form (PMF) Section C Provider Information Applies to rendering provider Rendering provider specialty Rendering provider national provider identification (NPI) number CAQH ID number Required for all providers that require credentialing 17 17

18 Online Provider Maintenance Form (PMF) Section D Autism providers only Access under Provider Forms Fill able forms can be printed, signed, scanned and attached to the PMF or faxed 18 18

19 Online Provider Maintenance Form (PMF) Section E Practice Address - The primary practice address for the rendering provider address must be populated - Group address is preferred Payment address if different can be PO Box (submit in pay to loop on electronic claims) 19 19

20 Online Provider Maintenance Form (PMF) Section F Practice Address Changes If changing an address, enter NEW information this section

21 Online Provider Maintenance Form (PMF) Section G Additional Office Locations Report two to five additional practice locations 21 21

22 Online Provider Maintenance Form (PMF) Section H Covering physicians not required for WI 22 22

23 Online Provider Maintenance Form (PMF) Section I Patient information Used by behavioral health providers only 23 23

24 Online Provider Maintenance Form (PMF) Section J Provider s Self Reported Areas of Expertise Used by Behavioral Health providers only 24 24

25 Online Provider Maintenance Form (PMF) Section K Attachments 25 25

26 Online Provider Maintenance Form (PMF) Section L Comments Important Include contact name, phone number and address and any additional comments for this submission 26 26

27 Online Provider Maintenance Form (PMF) Submission Confirmation Number 27 27

28 New Providers Approval Notification Online Provider Maintenance Form (PMF) Starts the provider addition/registration process Anthem provider registration confirmation o Provider effective date 30 days from date completed submission is received by Anthem Routes data to Anthem Credentialing o Anthem Credentialing approval notification Handouts: 1) Provider Affiliation Letter Sample 2) Provider Credentialing Letter Sample 28 28

29 Provider Changes and Terminations Demographic changes Submit an online Provider Maintenance Form (PMF) Address changes Submit an online Provider Maintenance Form (PMF) Terminations Submit an online Provider Maintenance Form (PMF) 29 29

30 Provider Changes and Terminations Tax Identification Number Changes Submit an online Provider Maintenance Form (PMF) Contracts are not transferable Contact your Network Relations Consultant 30 30

31 Links and Handouts CAQH ProView Overview, User Guides & Log in: Provider Forms Page: Online Provider Maintenance Form (PMF) Provider Forms Page: Provider Additions and Maintenance Reference Tool Provider Forms Page Autism Certification Forms Handouts Provider Affiliation and Provider Credentialing Letter Samples 31 31

32 32 32

33 Working with Anthem Subject Specific Webinar Series Please complete the Webinar Evaluation Survey Individuals completing the evaluation survey within 2 business days will be eligible for a Blue Prize package. Winner will be notified by within 3 business days 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

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