Network Update. In this issue. A note from our Medical Director 3. Meet our new Medical Director 3

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1 Network Update BEHAVIORAL HEALTH June 2014 In this issue Announcements and General Updates Billing A note from our Medical Director 3 Meet our new Medical Director Behavioral Health Provider Satisfaction Survey results Accessibility Survey results: Behavioral Health and EAP 5 Contract compliance with Accessibility Standards for Emergency Care Instructions and After-Hours Care 7 Check it out! The Behavioral Health Provider Resources web page 9 Statement regarding delay of ICD-10 compliance date 9 The final Mental Health Parity Rule released 9 Reimbursement policy change: CPT code New online processes for Electronic Remittance Advice (ERA) only registration and suppression of paper remittance vouchers 10 Claims submission tip 11 How to obtain language assistance 11 Verify member grace period status electronically using Availity 11 Effective July 1, 2014, pre-service review is required for all inpatient facility services 14 New electronic provider access (EPA) feature available 14 New 1500 Claim Form should be submitted using appropriate claim software and data element requirements 15 Page

2 In this issue Anthem Blue Cross provides guidance for overpayments and recoveries reported on the HIPAA 835 electronic remittance advice 15 Changes in recovery letters 18 Duplicate claims handling for Medicare crossover 18 Billing for Medicare primary members correct use of the GY modifier 18 Why call? Rate information is available online 19 Contracted provider claim escalation process 19 Electronic funds transfer election 20 Network Provider webinars: June sessions 20 Moved your office? 21 Contacting Behavioral Health Network Management 21 Covered California and behavioral health 21 Attention Psychiatrists and Psychiatric Mental Health Nurse Practitioners 21 Claim payment delays 21 Our Medi-Cal Behavioral Health Network 22 Coordination of care has a big impact 23 Anthem EAP is opening the network to more California (CA) providers! 23 Sign-up now for our Network eupdate today it s free! 24 Network leasing arrangements 24 Autism Spectrum Disorder (ASD) and Applied Behavior Analysis (ABA) 25 Find answers to BlueCard Questions 26 Health Care Reform Updates New articles available online 26 Guidelines and Quality Programs Access Standards 27 Clinical Practice and Preventive Health Guidelines available on the web 28 Misrouted Protected Health Information (PHI) 28 Member Rights and Responsibilities 29 Pharmacy Pharmacy information available on anthem.com/ca 29 Page Behavioral Health Network Update is published four times a year by Anthem Blue Cross Granite Ridge Drive, 6th Floor San Diego, California Editor: Jeannieann Galambos [email protected]

3 Announcements and General Updates A note from our Medical Director Robert Friedman, MD For those of you who had a moment to read the Anthem Blue Cross Behavioral Health Network Update in March 2014, you may have noticed that Paul Keith, MD, retired from his position as the Behavioral Health Medical Director. Paul reminded us that change is inevitable. As challenging as it may be for us to sometimes accept, change is one constant that we can count on. In 2013, we began to adjust to new CPT codes. In 2014, we are about to adopt DSM-5. Asperger s Disorder and Five Axes are out, while Disruptive Mood Dysregulation Disorder and Specifiers are in. The impact that behavioral health conditions have on the outcomes of many peoples medical conditions is becoming increasingly recognized, measured and quantified. The increase in morbidity and associated health care costs, the decrease in work force productivity and the overall financial burden placed on our economy and society, as a result of untreated and under treated behavioral health conditions is no longer being trivialized or ignored. Change continues to take place all around us. Health insurance plans, including Anthem Blue Cross, also undergo constant change. Despite the changes, or perhaps as a result of them, we remain committed to improving the health and well-being of our members and ensuring our members receive the highest quality of care. We recognize the future of health care involves attending to the health care needs of the whole person, inclusive of behavioral health. In order to do so successfully there is a need for a strong network of quality behavioral health providers who are willing to work together in order to meet the behavioral health care needs of a vulnerable group of people. As in any relationship, there may be miscommunications, misunderstandings and even disagreements. You know from your therapeutic work and from your own personal relationships, however, that meaningful action requires effective communication in order to successfully resolve any problems or differences should they arise. As our health care system continues to change, together, we have an opportunity to contribute positively to the lives and well-being of the members, clients and patients for whom we have the privilege to serve. I am honored to join you in this opportunity. Meet our new Medical Director Robert Friedman, MD is board certified in child, adolescent and general psychiatry. He is a founding partner of PsyCare, Inc., a behavioral health provider group in San Diego, CA and joined Anthem Blue Cross as the Behavioral Health Medical Director - West region in March, Welcome, Dr. Friedman! BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

4 2013 Behavioral Health Provider Satisfaction Survey results At Anthem Blue Cross, we consider our relationships with you, our behavioral health providers to be of critical importance as we strive to achieve our mission of improving the lives of the people we serve and the health of our communities. As part of our compliance with the Department of Managed Health Care s ( DMHC ) Timely Access Regulations, the Plan participates in the annual ICE Provider Satisfaction Survey. The survey assesses participating providers satisfaction with the medical and behavioral health networks. Medical and Behavioral Health networks are surveyed separately. Each year, we reach out to you to evaluate our performance. Your participation is important as this feedback influences our decisions about operational changes. The results of our 2013 Provider Satisfaction Survey are shown in the graph below. Appointment for Urgent Care The graph above shows an increase in provider satisfaction for two categories of the Behavioral Health Network Provider Satisfaction survey: Q1. Referral/Prior Authorization Process (increase from 71.5 to 74.4%) and Q.6 Access to Non Urgent BH (increase from 71.6 to 74.8%). Your feedback is important to us. We firmly believe that by continuously monitoring our provider networks, and the service we provide you, we can forge a stronger collaboration, work together to solve health care issues, and truly transform health care for the better. Watch for the 2014 surveys, coming soon! BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

5 2013 Accessibility Survey results: Behavioral Health and EAP To support compliance with regulatory and accrediting bodies, an annual accessibility report is conducted to assess Behavioral Health and EAP provider compliance with the Anthem Blue Cross accessibility standards as outlined in the Anthem Blue Cross Professional Provider Manual. The survey is conducted during regular daytime hours, to demonstrate timely access for behavioral health members and EAP clients seeking routine, non-life threatening emergency and urgent care appointments. The survey was conducted in October 2013 by a vendor, North American Testing Organization (NATO). Results of the 2013 survey are shown in the tables found on the next page. Appointment for Non-Life Threatening Emergency Care Appointment for Non-Life Threatening Care declined for MD/DO (Psychiatrists) and for Non-MD/DO (Psychologists and Master Levels). EAP compliance dropped from 89 to 80%, falling below the threshold. Appointment for Routine Care Appointment for Routine Care measure exceeded the goal in the categories of MD/DO (Psychiatrists), Non-MD (Psychologists and Master Levels) and EAP. MD/DO compliance increased to 100%. Non-MD/DO compliance increased slightly from 94 to 96%. EAP compliance dropped from 96 to 94%. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

6 Appointment for Urgent Care Appointment tor Urgent Care results continue to exceed the target at 100% for all provider types. Appointment Coverage When Unavailable Appointment Coverage When Unavailable resulsts remains at 96% all provider types. How Can You Make a Difference? Review Anthem Blue Cross Access Standards under the Rights and Responsibilities section and Quality Improvement section of your Anthem Blue Cross Professional Provider Manual. Make sure your practice policy and procedures comply with the standards. We value your participation in the Anthem Blue Cross Behavioral Health Network, and appreciate you working with us in meeting compliance with established access standards. If you have any questions, feel free to contact Behavioral Health Provider Relations by at [email protected] BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

7 Contract compliance with Accessibility Standards for Emergency Care Instructions and After-Hours Care As you know, Anthem Blue Cross monitors member access to Behavioral Health care through a number of mechanisms; two of which are annual telephone surveys to provider offices. These surveys are conducted by the ICE (Industry Collaborative Effort) After Hours team and NATO (North American Testing Organization). In addition, the ECHO member experience survey (Experience of Care and Health Outcomes) provides us with the member s perspective related to access to Behavioral Health After-Hours care. This information also helps to determine provider compliance with Accessibility Standards for Emergency Care Instructions and Access to After-Hours Care for our members. In surveying compliance with after-hours standards, participating providers offices are called outside of normal business hours to determine if callers are given appropriate emergency instructions, and have a mechanism to reach a provider after regular hours for urgent situations. Members who have received behavioral health care within the previous year are also surveyed. This member survey is conducted via a mailing to members. These surveys combined, in addition to monitoring of member complaints, help us to identify whether access to care is available to our members after or before normal business hours. The key to our 2014 success is.you! We thank those of you who have already taken steps to comply with the standards. Your efforts make a direct positive impact to the level of service and access to care for our members. We need your continued commitment in helping us achieve the best results possible for our 2014 surveys, which will be conducted over the next few months. In an effort to improve our results for 2014, Anthem Blue Cross is sharing the 2013 year results. For your reference, we have included them in the table on the next page. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

8 ECHO Member Experience Survey 2012 and 2013 Question Got help or advice when calling after regular office hours Results 2012: 82.6% and 2013: 82.8% ICE Provider After Hours Survey 2012 and 2013 Question Threshold > 85% of providers comply with the standard What would you tell a caller who states he/she is dealing with a life-threatening emergency? Results Medical % Medical % Behavioral Health 73.6% Behavioral Health 79.5% Compliant Answers: Hang up and dial 911 or go to the nearest emergency room; Go to the nearest emergency room; or Hang up and dial 911. Urgent Requests After Hours. In what time frame can the patient expect to hear from the provider or on-call provider? Note: Providers are expected to provide a specific time frame in that a member can expect a return call. If a specific time frame is not provided, the answer is considered non-compliant. Medical % Behavioral Health % Medical % Behavioral Health % How Can You Make a Difference? Review Anthem Blue Cross Access Standards under the Rights and Responsibilities and Quality Improvement sections of your Anthem Blue Cross Professional Provider Manual and make sure your practice policy and procedures comply with the standards. Ensure your after-hours office staff, answering service and/or answering machine message specifically inform callers as to when their urgent (non-emergent) calls will be returned. Ensure your after-hours office staff, answering service and/or answering machine message directs callers to dial 911 or go to the nearest emergency room if they believe they are experiencing an emergency. If your office was surveyed in 2013 and found non-compliant with these after-hours requirements, you will receive a letter with recommended compliance meausres to ensure prompt changes are made prior to the commencement of the 2014 after-hours surveys. We value your participation in the Anthem Blue Cross Behavioral Health Network, and appreciate your efforts to partner with us in meeting compliance with established access standards. If you have any questions, please feel free to our Provider Relations team at [email protected] BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

9 Check it out! The Behavioral Health Provider Resources web page Behavioral Health Networks created a consolidated provider web page on anthem.com/ca to enhance our online presence and serve as a one-stop shop for California behavioral health information and resources. The web page, Behavioral Health Provider Resources, is a comprehensive resource link to specific behavioral health information. Go to anthem.com/ca, click Providers and then Enter. On the Provider Home Page, scroll to the link Behavioral Health Provider Resources. It s that easy, check it out! Statement regarding delay of ICD-10 compliance date On April 1, 2014, the Protecting Access to Medicare Act of 2014 was signed into law. The bill includes a provision that effectively delays the implementation of ICD-10 diagnosis and inpatient procedure codes for at least one year. Anthem is committed to meeting the requirements of all mandates, including the implementation of the ICD-10 code set. We are currently assessing the impact of this change. Our plans will continue to be updated as we receive more information about the ultimate ICD-10 implementation date. Anthem is able to accept the revised CMS-1500 claim form (incorporating changes that will accommodate ICD-10) that became effective on April 1, No ICD-10 codes should be submitted on claims, however until the mandated compliance date. Note that the new version of the form is not required, and Anthem will be able to accept and process claims submitted using either version of the form. Anthem will continue to work to help ensure that our systems, supporting business processes, policies and procedures successfully meet the implementation standards and deadlines without interruption to day-to-day business practices. We will be capable of accepting and processing ICD-10 diagnosis and inpatient procedure codes on the mandated compliance date. The final Mental Health Parity Rule released The federal government released the final Mental Health Parity Rule on November 13, This replaces the temporary rule from February As a result, Anthem Blue Cross will apply this final rule to its new or renewing benefit plans, effective on or after July 1, The intent of the rule is to ensure that patient access to mental health or substance abuse services is the same access to medical services. Note: The Affordable Care Act (ACA) or health care reform law expanded the mental health parity rule to affect small group and individual plans. Grandfathered small group are still exempt from the law and benefit plans (small group or individual) purchased under Medicare. For more on the rule please click here. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

10 Reimbursement policy change: CPT code CPT code is described in the CPT manual as, Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, e.g., acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities), per hour of the psychologist s or physician s time, both face to face time with the patient and time interpreting test results and preparing the report. Anthem Blue Cross, consistent with CPT guidance restricting billable code use to neuropsychologists and physicians, will later in 2014 limit 5 units of per year per patient to ensure the code is being used appropriately. Instances of services exceeding 5 hours per year will be subject to review for case-specific detail. Medicaid and Medicare plans may have additional regulations and other guidance about utilization. This policy applies to all other health plans. In addition to the information provided here, you re encouraged to consult state licensing laws, CPT resources and information provided by various professional societies such as the American Academy of Neurology or the American Academy of Pediatrics. If you have any questions, Behavioral Health Provider Relations at [email protected] New online processes for Electronic Remittance Advice (ERA) only registration and suppression of paper remittance vouchers Anthem Blue Cross will soon implement a new online Electronic Remittance Advice (ERA) only registration process. This process will eliminate paper requests. We expect the online process to begin in August Once available, providers and third party billing agents, will be able to access the new online registration link via Anthem Blue Cross s EDI website at anthem.com/edi, and selecting California. Anthem Blue Cross will introduce the online ability for providers to control receipt of their paper remittance vouchers by mail (August 2014). Anthem Blue Cross discontinued mailing paper remittances in 2009 for all providers who were registered for Anthem Blue Cross s secure provider portal, ProviderAccess. In support of HIPAA Administrative Simplification requirements, Anthem Blue Cross will discontinue mailing paper remittance vouchers beginning September 2014, to providers who receive ERA, and are registered ProviderAccess portal users. Paper suppression will automatically occur 31 days after a provider registers for ERA. Anthem Blue Cross will provide additional details about these upcoming enhancements as information is available. Providers registering for ERA and EFT at the same time should continue to use the CAQH website. Information about registering for ERA and EFT at the same time can be found here. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

11 Claims submission tip Beginning June 1, 2014, any professional medical provider claims involving TPA s Advanced Benefit Solutions or Tribal Health Partners need to be submitted to the address below: P.O. Box Los Angeles, CA How to obtain language assistance Our members count on you. They may have questions, but language barriers prevent them from communicating. Anthem Blue Cross 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 at no cost. Anthem Blue Cross 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 Blue Cross to help with member needs English TTY or English Voice. Verify member grace period status electronically using Availity The Affordable Care Act (ACA) mandates a three month grace period (click here to view our previously published grace period article) for individual members who 1) purchase an ACA-compliant health plan on the Exchange, 2) receive a government-subsidized Advanced Premium Tax Credit or APTC (often referred to as a premium subsidy), and 3) are delinquent in paying their portion of premiums. This three month grace period applies after the individual has paid at least one month s premium within the benefit year. It is important for providers to be able to identify when a member is in a three month grace period, because claims for services rendered during the second and third month of the grace period will be contested and pended until the member s portion of the premium has been paid. Anthem Blue Cross is pleased to announce that providers can now determine if an Anthem Blue Cross member is in the second or third month of an ACA-mandated three month grace period by using our real time electronic 271 eligibility and benefit transaction available via Availity. If you previously called Anthem Blue Cross s Provider Service department to confirm grace period status for a member, you may now save valuable time by accessing member grace period status electronically via Availity. Frequently Asked Questions Q1. How can a provider identify a member in the second or third month of a grace period on Availity? BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

12 A1. The eligibility and benefit transaction will return an eligibility status of INACTIVE PENDING INVESTIGATION when a member is in the second or third month of an ACA-mandated three month grace period. Q2. Does Anthem Blue Cross currently return the eligibility status, INACTIVE PENDING INVESTIGATION for any circumstance other than notifying a provider that the member is in the second or third month of a grace period? A2. No. This eligibility status message is used only when a member is in the second or third month of a grace period. Q3. How will the member eligibility status appear if the member is in the first month of the grace period? A3. The member will appear as an active member. Q4. How will eligibility for a member in the second or third month of a grace period display when a provider submits a request for precertification using Anthem Blue Cross s online Interactive Care Reviewer (ICR) tool? A4. The ICR will also display the eligibility status INACTIVE PENDING INVESTIGATION. Q5. Can a provider continue to use the ICR to submit a request for precertification when the member s eligibility is displayed as INACTIVE PENDING INVESTIGATION (the member is in the second or third month of a grace period)? A5. Yes. The provider can continue with a precertification request using ICR. If a member is in the second or third month of a grace period, providers will see the following message on ICR. This subsidy-eligible member is not current with his/her premium payment and is in the 2nd or 3rd month of the grace period. Individuals receiving an advanced premium tax credit have a three-month grace period to pay their premium. We will pay claims incurred by covered members during the first month. During the second and third months of the grace period, the claims will be contested and pended if the premium hasn t been paid. Accordingly, any certification that services are medically necessary is not a guarantee of eligibility or that benefit will be provided. You must confirm eligibility prior to providing services pursuant to this certification by calling the UM number on the back of the member s card. Q6. Why doesn t the eligibility status for members in a grace period mention the grace period? A6. Electronic transactions must follow current HIPAA approved transaction guidelines. There are no HIPAA approved eligibility transaction codes that indicate a member grace period. To help distinguish members in a grace period, Anthem Blue Cross is using a HIPAA approved eligibility code that is currently not used for any other eligibility status. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

13 Q7. Will Anthem Blue Cross continue to enhance the information available to providers about member grace periods via Availity? A7. Yes. We will continue to work towards providing more information about member grace periods for providers via Availity. We will communicate this information, when it becomes available, in the Network Update newsletter, via Network eupdate s and/or on the public provider portal. Q8. Can a provider bill the member for services rendered when a three month grace period expires and the policy or health plan is terminated for non-payment? A8. The terms and conditions of the provider contract apply to care rendered to Covered Persons. When a policy or plan is terminated due to non-payment, the individual is no longer a Covered Person and the provider may bill the individual for services rendered. Q9. Can a provider ask the member to sign a waiver acknowledging the member will be financially responsible if the premium is not paid and the policy is terminated? A9. Providers currently use waivers for elective procedures and other services that are often non-covered services. Providers may ask members in a grace period to sign similar waivers for services rendered during the second or third month of the grace period. Please note that a waiver is not required to bill a member for services, should the health plan terminate for non-payment. However, a waiver may assist in provider collections and/or encourage the member to make their premium payment before the service is rendered. Q10. Can a provider decline to provide services, or ask for upfront payment, if the member is in the second or third month of a three month grace period? A10. We will not consider a provider s refusal to provide services or request for upfront payment during the second or third month of a grace period to be a breach of contract. Providers should refer members to Member Services for questions related to outstanding premium payments. Q11. How can I learn more about the ACA three month grace period and the processing of Anthem Blue Cross claims when a member is in a grace period? A11. Anthem Blue Cross previously published a communication about the three month grace period and you can access it here. The article provides a summary of the ACA-mandated three month grace period and sample scenarios about claim payment when a member is in the first, second, or third month of a grace period. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

14 Effective July 1, 2014, pre-service review is required for all inpatient facility services Effective July 1, 2014, the Par/Host Plan must require all participating providers to: Obtain Pre-Service Review for inpatient facility services unless otherwise specified in the Member and/or account contract. -- Providers must notify the Control/Home Plan within 48 hours when a change to the original Pre-Service Review occurs unless otherwise specified in the Member and/or account contract. Information on how to access and obtain precert is below. Obtain Pre-Service Review for emergency and/or urgent admission within 72 hours unless otherwise specified in the Member and/or account contract. Hold Members harmless when Pre-Service Review is required and not received for inpatient facility services, unless responsibility for Pre-Service Review is otherwise specified in the Member and/or account contract You may now obtain precert for out-of-state members through the Availity Web Portal for admissions, elective procedures and request approval for out-of-network services to be covered. Below is how to access this portal. Note: The above requirements do not apply to Federal Employee Plan (FEP) members. To obtain a pre-service review for FEP members, contact the customer service number on the back of the Member ID card. New electronic provider access (EPA) feature available Anthem Blue Cross now offers the ability to precert out-of-state members through Availity Web Portal. This new functionality routes providers to the home plan of an out-of-state member and from there, providers can access the home plan s electronic precert capabilities, if available. (Note: In accordance with a BCBSA mandate, Blue Cross Blue Shield plans have until mid-2014 to fully comply if they offer an electronic precert tool.) To access this functionality via the Availity Web Portal, users must have access to Authorization and Referral Request and select Authorizations under Auths and Referrals on the Availity left navigation menu. Users then choose Anthem Blue Cross as the payer, choose their organization if applicable, and then enter the prefix of the member being precerted along with the expected date/s of service. If the prefix is for an out-of-state member, users will be prompted to add their Tax ID and NPI. At that point, users will then be routed to the electronic precert tool for the member s home plan, if available. If the home plan does not have electronic capabilities, then traditional phone or fax methods of precert need to be utilized. If you have questions, please contact your local Provider Relations consultant, or contact Availity at BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

15 800-AVAILITY ( ) or questions to Availity Client Services is available Monday-Friday, 8 a.m. to 7 p.m. ET (excluding holidays). Availity, an independent company, provides claims management services for Anthem Blue Cross. Billing New 1500 Claim Form should be submitted using appropriate claim software and data element requirements In June 2013, the National Uniform Claim Committee (NUCC) announced the approval of an updated 1500 Claim Form (version 02/12) that accommodates reporting needs for ICD-10 and aligns with requirements in the Accredited Standards Committee X12 (ASC X12) Health Care Claim: Professional (837P) Version 5010 Technical Report Type 3. On April 1, 2014, the Protecting Access to Medicare Act of 2014 was signed into law, and this bill includes a provision that effectively delays the implementation of ICD-10 diagnosis and inpatient procedure codes for at least one year. Anthem Blue Cross continues to accept claims submitted using the updated 1500 Claim Form (version 02/12). Providers should take special care to ensure billing areas utilize claim software that supports the corresponding 1500 Claim Form version submitted to Anthem Blue Cross. For example, if you are submitting paper claims on version 02/12 of the 1500 Claim Form, please be sure that your office is using claim software that supports the 02/12 version of the 1500 Claim Form. Claims submitted with mismatched form types and data elements will be rejected. Additionally, please check the alignment of data elements on your paper claims to ensure they are properly aligned in their designated field(s). Please follow the guidelines set forth by the NUCC for completing the new 1500 Claim Form, or your claim may be rejected. For more information about the revised 1500 Claim Form, please visit the National Uniform Claim Committee website, which provides helpful resources such as a list of changes between the 08/05 and 02/12 claim versions and the 1500 Instruction Manual. Anthem Blue Cross provides guidance for overpayments and recoveries reported on the HIPAA 835 electronic remittance advice Beginning second quarter 2014, Anthem Blue Cross will be making some changes in the way we are reporting overpayment and recoveries for the electronic remittance advice also called the HIPAA (Health Insurance Portability and Accountability Act) 835 transaction. It is important to note that we are not changing our electronic data interchange (EDI) processes. We are simply making changes to help ensure information we report is uniform and consistent on the HIPAA 835 transactions we send you. We are implementing the changes in a phased approach. This means that you will see some changes on provider level adjustments on the HIPAA 835 transactions for some of your claims beginning second BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

16 quarter. You may notice the volume for the HIPAA 835 transactions with the new changes will increase over time, as we complete our implementation efforts across our internal systems. Summary of the changes The following table presents four provider level adjustment codes and an explanation of their use. Provider level adjustments appear in the PLB segment on the 835 electronic remittance advice. The adjustments are not always associated with a claim in the same 835, but these are needed to balance the 835 at the transaction (check) level. The adjustments will increase the payment when a negative money amount is returned, or decrease the payment when a positive money amount is returned. Provider Level Adjustment Code: WO Overpayment Recovery Reference Number: Patient Account Number + 1 st Date of Service + Claim Number Used when: A corrected and reversed claim record appears in the 835 and the monies are not immediately recovered. The PLB with a WO will be present with a negative money value. These monies will be recovered in a future 835. A previous overpayment is recovered. Monies will be expressed as a positive value. Acknowledging a refund sent by the provider for an overpayment notification. The WO with a positive money value will be offset by a 72 with a negative money value. Example: PLB* * *WO:PTACCT# CCYYMMDD CLAIM#*-37.5~ Provider Level Adjustment Code: 72 Authorized Return Reference Number: Patient Account Number + 1 st Date of Service + Claim Number Used when: Acknowledging a refund sent by the provider for an overpayment notification. The WO with a positive money value will be offset by a 72 with a negative money value. Example: PLB* * *WO:PTACCT# CCYYMMDD CLAIM#*25*72: PTACCT# CCYYM- MDD CLAIM#*-25~ Provider Level Adjustment Code: CS Adjustment Reference Number: Patient Account Number + 1 st Date of Service + Claim Number Used when: A refund received from a provider triggers a previously paid claim to adjust. A corrected and reversed claim record appears in the 835, and the refunded monies appear as a positive money value in the PLB with a CS qualifier. Example: PLB* * *CS:PTACCT# CCYYMMDD CLAIM#*100~ BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

17 Provider Level Adjustment Code: FB Forwarding Balance Reference Number: Current Check # (TRN02) value Used when: An overpayment can t be recovered in full resulting in a forwarding balance to be recovered from a future payment. An existing forwarding balance can t be recovered in full resulting in a new forwarding balance. The TRN02 values will be as defined in the X12 Standards for Electronic Data Interchange Technical Report Type 3 (TR3). Example: PLB* * *FB: Check#*-37.5~ Anthem Blue Cross is working to make these changes as seamless as possible, and we want to help ensure your electronic claim submissions are not negatively impacted. We continue to strive to the level of service you ve come to expect from us with consistently prompt and accurate payments. We encourage you to consult with your programmer, vendor or clearinghouse to determine whether the changes we are making will have any impact to your current electronic processes for your 835 transactions. As a reminder with any technical change, we suggest that you: Monitor claim submissions closely using your daily claim reports. Reconcile each electronic submission to make sure all claims were received by each payer and were submitted correctly. Anthem Blue Cross provides daily reports with complete claim receipt status details. Check with your vendor or clearinghouse to make sure you re receiving this information.) Review remittance vouchers often for unanticipated reductions in reimbursement or other payment trends. You can call our EDI specialists toll free at if you have questions about your electronic remittance advice. (Contact our provider services area with claims specific questions.) Use to verify claim receipt, remittance totals and claims payments. Contact your programmer, vendor or clearinghouse immediately if you notice any unusual or unexpected changes or differences on your daily reports or remittance vouchers. Additional information Further details about these and other PLB qualifiers and their use are available in the ASC X12 Standards for Electronic Data Interchange Technical Report Type 3 (TR3). To learn more, visit us on the Web at anthem.com/edi. Select California and then the Communications tab. Next, select Latest News. Or, if you prefer, select the following link: culdesac?name=edi&content_path=provider/f1/s0/t0/pw_a htm&label=overview BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

18 Changes in recovery letters In January of this year, we made a change to our recovery letters to include a COUPON on the bottom, front page of your recovery notification letter. We are asking that you detach the coupon and return it along with your payment in order to ensure faster processing and more accurate posting. We ve also changed our remit address for these letters. When returning payments that have the coupon included, please send your payments to the following address: P.O. Box 5281 Carol Stream, IL This new address only applies to the new letters having a coupon attached and should not replace the existing lockbox address for voluntary refunds, returned check issues, or any other type of correspondence that do not have a coupon included. We appreciate you working with us to expedite your payment, improve accuracy, and reduce the chances of HIPAA privacy breaches. If you have any questions, please call the number indicated at the bottom of your letter. Duplicate claims handling for Medicare crossover Since January 1, 2006, all Blue plans have been required to process Medicare crossover claims for services covered under Medigap and Medicare Supplemental products through Centers for Medicare & Medicaid Services (CMS). This has resulted in automatic submission of Medicare claims to the Blue secondary payer to eliminate the need for the provider s office or billing service to submit an additional claim to the secondary carrier. Additionally, this has also allowed Medicare crossover claims to be processed in the same manner nationwide. When a Medicare claim has crossed over, providers are to wait 30 calendar days from the Medicare remittance date before submitting a claim. Providers can identify if a claim has been crossed over for secondary payment by identifying the following Medicare Remittance Advice remarks: Medicare remittance advice remark codes MA18 or N89 that Medicare crossover has occurred MA18 Alert: The claim information is also being forwarded to the patient s supplemental insurer. Send any questions regarding supplemental benefits to them. N89 Alert: Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice. Billing for Medicare primary members correct use of the GY modifier In October, Anthem Blue Cross implemented new guidelines to help reduce the administrative work associated with Medicare crossover claims filing. To help ensure timely and accurate payment, please review the following information for filing claims for Medicare statutorily excluded services. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

19 The Centers for Medicare & Medicaid Services has a list of statutorily excluded services or services that Medicare will not reimburse. CMS has established a GY modifier to indicate to secondary and tertiary payers a statutorily excluded service. While Medicare never covers statutorily excluded services, in some instances, a secondary payer, such as Anthem Blue Cross, may cover all or a portion of those services. To expedite payment when submitting a claim for statutorily excluded services, only services with the GY modifier should be submitted on the claim. If other non-statutorily excluded services are rendered, those services should be split off the claim and submitted on a separate claim. If providers submit combined line claims (some lines with the GY modifier, some without) to their local plan, the provider s local plan will deny the claims, instructing the provider to split the claim and resubmit. Original Medicare - The GY modifier should be used when service is being rendered to a Medicare primary member for statutorily excluded service and the member has Blue secondary coverage, such as a Anthem Medicare Supplement plan. The value in the SBR01 field should not be P to denote primary. Medicare Advantage - Please ensure SBR01 denotes P for primary payer within the 837 electronic claim file. This helps ensure accurate processing on claims submitted with a GY modifier. The GY modifier should not be used when submitting: Commercial claims Federal Employee Program claims In-patient institutional claims. Please use the appropriate condition code to denote statutorily excluded services. Providers can call the E-Solutions HelpDesk at or go to anthem.com/edi to request assistance with submitting electronic claims to us. For questions regarding where to file paper claims, please contact the provider call center. If you are located in California, Nevada, Colorado, Georgia, Maine or New Hampshire please call Y0071_14_19150_I 01/14/2014 Why call? Rate information is available online To view this secure information you need a ProviderAccess account. Don t have a ProviderAccess account? Just click here and register today! Contracted provider claim escalation process In an effort to better service our contracted providers right the first time, Anthem Blue Cross has improved our provider claim escalation process. Just click, Provider Claim Escalation Process to read, print, download and share the improved process with your office staff. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

20 Our Provider Relations Team is available by at to answer questions you have about the process. Electronic funds transfer election Per HIPAA, we are required to offer Electronic Fund Transfers to Providers. Should a Provider or Facility elect to receive payments via Electronic Fund Transfer, such election may be deemed effective by Anthem for any Claim your Agreement with Anthem pertains to. In support of CAQH Administrative Simplification rules, Anthem may share information about Providers or Facilities, including banking information, with third parties to facilitate the transfer of funds to Provider or Facility accounts. Network Provider webinars: June sessions Join us at our 2014 second quarter webinars! Our Provider Network Education team offers quality educational programs and materials specially designed for the office staff of physicians, hospitals, medical groups, ancillary and other health care professionals. Our complimentary education programs offer blended learning via face-to-face and web-based learning opportunities exclusively for our contracted provider network. You can find a complete schedule of our seminars, webinars, and on-demand e-courses, at our Anthem Blue Cross website: anthem.com/ca/home-providers.html. Scroll down to the SPOTLIGHT section and click on the 2014 Provider Education Seminars and Webinars link. Webinars - offer a live interactive, 90 minute session conducted remotely via the Internet and facilitated by the Provider Network Education team and Subject Matter Experts. Registration is open! Here is a listing of the topics and dates: Time: 10 a.m. 11:30 a.m. (PST) Complimentary June 11 - Provider Manual Overview [Professional] June 18 - Behavioral Health Practitioner & Office Staff Orientation June 25 - BlueCard [Out-of-Area] Refresher We also offer On-Demand, e-courses: quick, short, informative, self-paced instruction on a variety of individual topics. Our e-courses are available 24/7 at your convenience. A listing of the topics is available on the Provider Network Education web page. QUESTIONS: us at [email protected] BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

21 Moved your office? To ensure proper processing of all changes to addresses, tax ID numbers and provider profiles, please them to You can also send your changes by fax to or Keep in mind that all changes must be submitted on the physicians or medical group s letterhead and signed by the physicians or authorized personnel. Contacting Behavioral Health Network Management If you have questions about your rate schedule, contract language or requirements as specified in the Anthem Blue Cross Professional Provider Manual, you can our Behavioral Health Provider Relations team at [email protected] If you have a claims status question, start online with AVAILITY Web Portal, your multi-payer portal solution. Other options you have include contacting Provider Care or Customer Service at the phone number on the member s health care ID card. Covered California and behavioral health Did you know that all Covered California members have open access to our participating Anthem Blue Cross Behavioral Health providers? As an Anthem participating Behavioral Health provider, you can be assured that Covered California members are covered for services, and your current Anthem Behavioral Health Network contract rates (fee schedule) apply. Be sure to confirm benefits and eligibility for Covered California members as you would any other Anthem member before rendering services. Attention Psychiatrists and Psychiatric Mental Health Nurse Practitioners We offer reimbursement for Evaluation and Management services (formerly medication management) to Psychiatric Mental Health Nurse Practitioners? If you re a supervising Psychiatrist interested in your Psychiatric Mental Health Nurse Practitioner participating in the Anthem Blue Cross Behavioral Health Network, fax a letter of interest to us by at Go online to request participation in the Anthem Behavioral Health Network. Visit our provider website by clicking, Become an Anthem Behavioral Health Network Provider or follow the path anthem.com/ca > Providers > Enter > Behavioral Health Provider Resources > Become a Network Provider > Behavioral Health. Claim payment delays Timely notification of practice changes can prevent delays member care as well as claims payments. Make sure to notify us within 30 calendar days of such change(s). The Practice Update Form and BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

22 the Practice Profile are convenient online options for updating practice information with little effort or time. Use the Practice Update Form to change the following information: address Check/EOB/Remit address Mailing/Correspondence address Practice Address Phone and fax number Open /closed practice status Tax ID - include a W-9 form with your change National Provider Identifier Note: Address information should correspond to only one Tax Identification (Tax ID) per form. Use the Practice Profile when updating: Self-reported areas of expertise Open/closed practice status Age ranges treated Additional languages spoken Provider ethnicity (optional) You can access both fillable forms online. Go to the Behavioral Health Provider Resources web page at anthem.com/ca > Providers > Enter > Behavioral Health Provider Resources Once you submit your Practice Update Form consider this, forwarding your mailing and billing address with the post office until your practice information is changed can avoid interruptions. Our Medi-Cal Behavioral Health Network Anthem Blue Cross is responsible for providing access to some Behavioral Health services for Medi-Cal members in 29 California counties (see chart next page). We are responsible for members with mild to moderate impairment to functionality; members with severe impairment to functionality continue to be the responsibility of the county. The Medi-Cal Behavioral Health benefit includes psychiatric assessment, individual and group therapy, medication management, psychological testing, and substance abuse screening and brief intervention. Prior to rendering services to Medi-Cal members, please call UM at Fax your completed Outpatient Treatment Request forms to BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

23 Reimbursement for all license levels is based on the rates posted by Medi-Cal. To view rates, go online to files.medi-cal.ca.gov/pubsdoco/rates/rateshome.asp If you practice in any of the counties below, and wish to participate in the Medi-Cal Behavioral Health Network, your request to and attach these documents: resume, state practice license, completed Practice Profile, and malpractice face sheet. If you have any questions about the status of your contract, please Behavioral Health Provider Relations at Anthem s Medi-Cal Counties Alameda Contra Costa Los Angeles Plumas Sutter Alpine El Dorado Madera Sacramento Tehama Amador Fresno Mariposa San Benito Tulare Butte Glenn Mono San Francisco Tuolumne Calaveras Inyo Nevada Santa Clara Yuba Colusa Kings Placer Sierra Coordination of care has a big impact Coordination of care among providers is a vital aspect of good treatment planning to ensure appropriate diagnosis, treatment and referral. We, Anthem Blue Cross would like to take this opportunity to stress the importance of communicating with your patient s other health care providers. This includes primary care physicians (PCPs) and medical specialists, as well as behavioral health providers. 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 provider. We urge you to obtain the appropriate permission from these patients to coordinate care between Behavioral Health and other health care providers at the time treatment begins. We expect all health care providers to: Discuss with the patient the importance of communicating with other treating providers. Obtain a signed release from the patient and file a copy in the medical record. Document in the medical record if the patient refuses to sign a release. Document in the medical record if you request a consultation. If you make a referral, transmit necessary information; and if you are furnishing a referral, report appropriate information back to the referring provider. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

24 Document evidence of clinical feedback (i.e., consultation report) to include, but is not limited to: -- Diagnosis -- Treatment plan -- Referrals -- Psychopharmacological medication (as applicable) To facilitate coordination of care, we have tools available to you on our website including a Coordination of Care Form and Letter Templates. Start using them today! Got to anthem.com/ca > Providers > Enter > Behavioral Health Provider Resources > Coordination of Care Form and Letter Templates Anthem EAP is opening the network to more California (CA) providers! Anthem Employee Assistance Program (EAP) is now accepting applications to join the EAP from all participating CA Behavioral Health Providers. Go to Anthem EAP > Providers > scroll to Panel Consideration and follow the instructions to request an application. Sign-up now for our Network eupdate today it s free! Connecting with Anthem Blue Cross and staying informed will be even easier, faster and more convenient than ever before with our Network eupdates. Network eupdate is our web tool for sharing vital information with you. It features short topic summaries and links that let you dig deeper into timely critical business information: Important website updates System changes Fee Schedules Medical policy updates Claims and billing updates and much more Registration is fast and easy. There is no limit to the number of subscribers who can register for Network eupdates, so you can submit as many addresses as you like. Network leasing arrangements Anthem Blue Cross has network leasing arrangements with a variety of organizations, which we call Other Payors. Other payors and affiliates use the Anthem Blue Cross network. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

25 Under the terms of your provider contract, members of other payors and affiliates are treated like Anthem Blue Cross members. As such, they re entitled to the same Anthem Blue Cross billing considerations, including discounts and freedom from balance billing. You can obtain the Other Payors list on ProviderAccess which can be accessed through the Anthem Blue Cross website at anthem.com/ca. If you don t have internet access, please contact us at for assistance. Autism Spectrum Disorder (ASD) and Applied Behavior Analysis (ABA) New AMA ABA procedure Codes Are Coming! The American Medical Association (AMA) recently released their new universal ABA procedure codes with descriptions. Anthem will be in communication with you in the near future regarding using these codes for service provided to our members. Stay tuned! New ABA Clinical Guidelines. The new ABA Clinical Guidelines went into effect April 15, These replace previous Medical Necessity Criteria. A detailed notification including the full Guideline was mailed to you and is also available through the Anthem provider website portal. Please be sure to familiarize yourself and your staff with these guidelines if you will be requesting authorization for ABA services. ABA Claims Troubleshooting. Precertification is required for almost all Anthem plans and ABA billing codes. The one exception is H0031, which is intended for assessment only. We wish to continue to allow this code without precertification, so it is important to only use this code to reflect true assessment services. Treatment codes will not be paid prior to authorization. If you did not seek precertification prior to treatment you can request a retrospective review by calling or faxing the Behavioral Health Utilization Management Department. Claim-Authorization Fidelity. Many claims denials are simply due to a mismatch between what is authorized and what is subsequently billed. First, always review the authorization letter when it arrives to verify it reflects what you intend to bill. Please ensure your billing staff also has access to this document. Our ASD team is very focused on ensuring accuracy in our documentation and utilization management processes. We welcome your proactive partnership in this effort. If your ABA claim is denied the very first step you should take is to compare your claims submission with the authorization letter sent to you by Anthem. Verify that the procedure codes and individual provider and group provider name match. Also verify that the dates of service fall within the authorization period dates. If they do not match, you can correct your claim form and submit an adjusted claim for reimbursement. (Do not send in a brand new claim if you need to correct something, as these will deny for duplication. Always send in an corrected claim.) If you believe the authorization letter is incorrect please call the Behavioral Heath Utilization Management Department. If you are using a billing service, be sure to verify that they are following these steps on your behalf. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

26 Plan Benefits. ABA benefits should always be confirmed through Provider Care or the Availity Web Portal for every Anthem member. When calling Provider Care you may need to be routed to a team that is trained to quote ABA benefits. You can advise the Provider Care associate at the beginning of your call that you will need to speak with someone trained in ABA benefits. You may also ask if a callback is possible instead of continuing to hold. Finally, please note that occasionally ABA benefits are listed under the Rehabilitation benefit section. This does not change the benefit, but just where the benefit description can be located. Our Partnership. The ASD Team continues to be truly appreciative for the care that our providers of ABA services offer to our members with ASD and their families. Your partnership allows us the honor of working together for the health of our members and betterment of our communities. Find answers to BlueCard Questions As a participating provider of Anthem Blue Cross, you may render services to patients who belong to other Blue Plans and who travel or live in California. The BlueCard Program lets you conveniently submit claims to Blue Plans, including international Blue Plans, directly to Anthem Blue Cross. The Blue Card Program Provider Manual describes the advantages of the BlueCard Program, and provides information to make filing claims easy. It offers helpful information about verifying eligibility, obtaining pre-certification/pre-authorizations and who to contact with questions. You can easily view the BlueCard Program Provider Manual online, go to anthem.com/ca > Providers > Communications. Health Care Reform Updates New articles available online Anthem Blue Cross Engages Inovalon to Conduct Outreach Efforts for our Exchange Business - March We invite you to go to our website to learn about the many ways health care reform and health insurance exchange may impact you. New information is added regularly. To view the latest articles on health care reform and/or health insurance exchange, and all achieved articles, go to anthem.com/ca, select the Provider link in the top center of the page, and click Enter. From the Provider Home page, select the link titled Health Care Reform Updates or Health Insurance Exchange Information. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

27 Guidelines and Quality Programs Access Standards The following Behavioral Health and EAP provider access standards are for the delivery of clinical care conducted face-to-face. We ask that you comply with these Anthem Blue Cross Access Standards. Type of Care Emergency Care Instructions (California law requires health plans to follow the prudent layperson standard in providing direction for emergency care and prohibits plans from denying payment for emergency services, even if the situation was discovered not to be emergent, if any prudent layperson would have considered the situation to be an emergency. Therefore, Anthem Blue Cross expects every practitioner to instruct their after-hours answering service staff that if the caller believes they are experiencing an emergency, the caller should be instructed to dial 911 or to go directly to the emergency room. Answering machine instructions must also direct the member to call 911 or go to the emergency room if the caller believes they are experiencing an emergency). Non-Life Threatening Emergency Care Urgent Care (does not require prior authorization) Urgent Care (requires prior authorization) Standard Members are directed to 911 or the nearest emergency room. 6 hours 48 hours 96 hours Routine Office Visit/Non-urgent Appointment 15 Business days (Psychiatrists) 10 Business days (Non-Physician Mental Health Care Providers) 5 Business days (EAP) Access to After-hours Care In office waiting room time Available 24 hours/7 days. Member to reach a recorded message or live voice response providing emergency care instructions, and for non-emergent (urgent) matters, a mechanism to reach a Behavioral Health/EAP provider, and be informed when the call will be returned. Usually members do not have to wait longer than fifteen (15) minutes after their scheduled appointment to see a Behavioral Health/EAP provider. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

28 Members also have access to Anthem Blue Cross 24/7 NurseLine. The phone number is located on the back of their health care ID card. In addition, Members and Providers have access to Anthem Blue Cross s Customer Service team at the telephone number listed on the back of the member s health care ID card. A representative may be reached within 10 minutes during normal business hours. If you have questions, please contact our Behavioral Health Provider Relations team by at [email protected] For additional information about the regulations, please visit the Department of Managed Health Care s website at Commitment to our members health and their satisfaction with the care and services they receive is the basis for the Anthem Blue Cross Quality Improvement Program. Annually, Anthem Blue Cross prepares a quality improvement program description that outlines the plan s clinical quality and service activities and other quality initiatives. We strive to support the patient-physician relationship, which ultimately drives all quality improvement. The goal is to maintain a well-integrated system to continuously identify, measure, assess and improve clinical and service quality outcomes through standardized and collaborative activities. An annual evaluation is also developed highlighting the outcomes of these initiatives. To see a summary of Anthem Blue Cross quality program and most current outcomes, visit us on the web at the Anthem Blue Cross Quality Improvement Program 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, which are 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 anthem.com/ca Provider > Enter > Home Page and then Health & Wellness > Practice Guidelines. Misrouted Protected Health Information (PHI) Providers and facilities are required to review member information received from Anthem Blue Cross to help ensure no misrouted PHI is included. Misrouted PHI includes information about members that a provider or facility is not currently treating. PHI can be misrouted to providers and facilities by mail, fax or . Providers and facilities are required to immediately destroy any misrouted PHI or safeguard the PHI for as long as it is retained. In no event are providers or facilities permitted to misuse or re-disclose misrouted PHI. If providers or facilities cannot destroy or safeguard misrouted BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29

29 PHI, providers and facilities must contact Anthem s provider services area to report receipt of misrouted PHI. Member 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 providers and members (our covered individuals, your patients) in our system, Anthem Blue Cross has adopted a Member Rights and Responsibilities statement. It can be found on our website. To access go to the Providers home page at anthem.com/ca Providers > Enter > Health & Wellness > Quality Improvement > Member Rights & Responsibilities. Pharmacy Pharmacy information available on anthem.com/ca Visit anthem.com/pharmacyinformation for more information on 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. BEHAVIORAL HEALTH NETWORK UPDATE JUNE of 29