Credentialing and Provider Maintenance

Transcription

1 Anthem Blue Cross and Blue Shield Credentialing and Provider Maintenance Stacy Smith May 25, 2011 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. This presentation contains proprietary information of Anthem Blue Cross and Blue Shield Any redistribution or other use is strictly forbidden

2 Agenda Credentialing application Council for Affordable Quality Healthcare (CAQH) Online provider maintenance form Approval notification Provider changes and terminations Tax Identification Number Change 5/12/2011 2

3 Providers requiring credentialing Behavioral Health Facilities Acute Inpatient, Intensive Outpatient, Residential Treatment Professional Psychiatrist (MD), Psychologist (PhD, PsyD, EdD), Licensed Clinical Social Workers, Licensed Professional Counselors, Licensed Marriage and Family Therapist, Advanced Practice Nurse Prescribers (APNP) 5/12/2011 3

4 Providers exempt from credentialing Behavioral Health Professional Substance Abuse Counselor (SAC) Clinical Substance Abuse Counselor (CSAC) Licensed Independent Clinical Social Worker (LICSW) Note: Certified Alcohol and Drug Counselor I, II, and III (CADC I, CADC II, and CADC III) are now Substance Abuse Counselor (SAC) 5/12/2011 4

5 WI Autism Mandate State Statute (12m) and Senate Bill 667 Requires coverage for evidence-based therapy services for individuals with Autism Spectrum disorders Certification forms required in addition to credentialing for providers delivering therapy services Certification forms available under Provider forms faxed upon completion 5/12/2011 5

6 WI Autism Mandate State Statute (12m) and Senate Bill 667 Continued Qualified specialty specific provider certification forms 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 5/12/2011 6

7 Credentialing Application CAQH Required submission through Council for Affordable Quality Healthcare (CAQH) Meets URAC and NCQA data collection standards Enter data once for all national Health Plans Practice Administrator Module No cost to providers 5/12/2011 7

8 Credentialing Application Approval Complete & Accepted by CAQH Online Provider Maintenance Form (PMF) Submission Source Verification Anthem Credentialing Committee Approval Anthem 5/12/2011 8

9 Online Provider Maintenance Form (PMF) Available on our public website at under Provider Forms Enter provider information including CAQH ID if credentialing is required Print a copy for your records and submit Electronic routing to Anthem 5/12/2011 9

10 Online Provider Maintenance Form (PMF) Starts the provider addition/registration process Anthem provider registration confirmation Provider effective date 30 days from date completed submission is received by Anthem Routes data to Anthem Credentialing Credentialing approval notification 5/12/

11 Provider Changes and Terminations Demographic Changes Submit a Provider Maintenance Form Address Updates Submit a Provider Maintenance Form Terminations Submit a Provider Maintenance Form 5/12/

12 Provider Changes and Terminations Tax Identification Changes Submit a Provider Maintenance Form Contracts are not transferable Contact your Network Relations Consultant Stacy Smith (715) [email protected] 5/12/

13 Learn more Resource Tools on the Provider Education page of anthem.com See Web Meetings, April 2011 Behavioral Health Informational Provider Seminar Provider Additions & Maintenance Hand-Out Sample Provider Affiliation Letter Sample Credentialing Approval Letter CAQH Quick Reference Guide Additional training Your Network Relations Consultant 5/12/

14 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. 5/12/