Anthem Provider Expo Ellington Network Relations Specialist [email protected] Christine...
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Anthem Provider Expo Kentucky Medicaid
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Transcript of Anthem Provider Expo Ellington Network Relations Specialist [email protected] Christine...
Anthem
Provider Expo
Kentucky Medicaid
Session agenda
• Introductions
• Anthem Blue Cross and Blue Shield Medicaid (Anthem) – From the
beginning
• Medicaid membership
• Medicaid open enrollment
• Member benefits/eligibility
• Provider network
• Provider website
• ICD-10
• Important Anthem Medicaid contacts
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www.Anthem.com/KYMedicaiddoc Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., 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. WEB-AKY-0275-15 October 2015
Introductions
Jennifer Ecleberry
Director, Provider Solutions
Ken Groves
Manager II, Provider Network Management
Libby Ellington
Network Relations Specialist
Christine Goetz
Patient Centered Care Consultant
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Kentucky Medicaid regions
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Anthem Medicaid – From the beginning
• Effective January 1, 2014, Anthem Medicaid won the bid to become one of the five Managed Care Organizations (MCOs) in the state of Kentucky for newly eligible recipients through the Affordable Care Act. At that time, Anthem operated in only seven of the eight Medicaid regions (excluded region 3).
• Effective July 1, 2015, Anthem Medicaid won the bid to remain one
of the five MCOs but moved into all eight Medicaid regions and became an option for all eligible recipients, including the existing Medicaid population (TANF, CHIP).
• All five MCOs operate statewide and include: – Anthem Medicaid
– CoventryCares of Kentucky
– Humana – CareSource
– Passport Health Plan
– WellCare
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Kentucky Medicaid membership
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Kentucky Medicaid membership count 1,302,610
Plan type Member count
Anthem Medicaid 77,438
CoventryCares of Kentucky 292,760
Medicaid FFS 120,085
Humana - CareSource 118,113
Passport Health Plan 262,906
WellCare 431,093
KY Data Warehouse Weekly Membership Counts as of 8/31/15 – Department for
Medicaid Services
Anthem Medicaid membership
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Anthem Medicaid membership count 77,438
Medicaid region Member count
Region 1 5,227
Region 2 8,547
Region 3 2,694
Region 4 13,830
Region 5 20,817
Region 6 7,230
Region 7 6,124
Region 8 12,929
KY Data Warehouse Weekly Membership Counts as of 8/31/15 – Department for
Medicaid Services
Medicaid open enrollment
• The Department for Medicaid Services (DMS) will be conducting an
open enrollment for eligible recipients in a managed care plan
starting October 19, 2015 – December 11, 2015.
• DMS will be mailing open enrollment packets to each eligible
recipient.
• This will be a passive open enrollment, which means that recipients
will not have to take any action if they would like to continue with
their current MCO.
• All plan changes will take effect January 1, 2016.
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Why Anthem Medicaid?
Value-added Benefits
Anthem Medicaid is pleased to offer valuable member
benefits in addition to the standard Medicaid covered
benefits. A few of these include:
– No copayments
– Sports physicals for members ages 6-18
– Boys & Girls Club membership for members ages 6-19, with
after-school care, at participating locations
– Prenatal Rewards Program, including a free portable crib or car
seat and gift cards
– Smoking cessation support group
– Care on Call nurse triage line – available 24/7
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Member eligibility
• Medicaid eligibility is determined by the member’s Department for
Community Based Services (DCBS) in the county in which the
member resides.
• The Department for Medicaid Services provides eligibility
information to Anthem Medicaid on a daily basis.
• For Anthem Medicaid, a member must select a primary care
provider (PCP) at the time of enrollment, but referrals are not
required for specialty care.
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Anthem Medicaid ID card
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Provider network
• The Medicaid provider network was built by amending the
Anthem commercial network agreements to add the Medicaid
product and plan requirements.
• We have a very comprehensive, statewide network that
includes over 18,000 providers.
Hospital 97
PCP 3,555
Specialist 13,327
Behavioral health 1,462
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Provider network (cont.)
• The credentialing process for Anthem Medicaid is generally
the same as the process utilized by Anthem commercial.
• A Council for Affordable Quality Healthcare (CAQH)
application is required.
• An active KY Medicaid ID is required.
• The credentialing time frame averages 30 days for completion
from the time complete and accurate information is received
by Anthem.
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Anthem Medicaid provider website
www.anthem.com/kymedicaiddoc
• The provider website is available to all providers,
regardless of participation status.
• Availity registration is required to perform many key
transactions. •Precertification submission
•Precertification status lookup
•PCP panel listings
•Member eligibility
•Claim status
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Anthem Medicaid provider website (cont.)
• Authorization requests can be submitted online through Availity via
fax or by calling Provider Services at 1-855-661-2028.
• Precertification Lookup Tool is available on the website:
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ICD-10 – Are you ready?
• ICD-10 implementation was effective October 1, 2015, as mandated by the
Health Insurance Portability and Accountability Act (HIPAA).
• ICD-10-CM has greater clinical specificity. The new diagnosis code set
allows providers to report many additional details about the patient’s
condition(s).
• As part of Anthem’s approach to discovering, understanding and predicting
the impact of ICD-10, extensive end-to-end testing has been conducted with
selected providers and clearinghouses.
– The test claims included inpatient, outpatient and professional claims for
various specialties.
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ICD-10 – Are you ready? (cont.)
ICD-10 coding guidelines for preauthorizations and claims submission by type of service
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Type of Service Begins Ends Pre-Authorization Claim
Inpatient
Admission begins on or after the compliance date
Discharge on or after the compliance date
Preauthorization must be requested with ICD-10 codes.
Claim for services rendered on or after the compliance date must be billed with ICD-10 codes.
Inpatient with unknown discharge date
Admission begins before the compliance date
Unknown at the time of admission, then discharge occurs on or after the compliance date
Preauthorization must be requested with ICD-9 codes. This preauthorization will be valid for the entire admission.
The code set used on the claim will be based on the discharge date, so the entire claim must be billed with ICD-10 codes.
Inpatient with known discharge date
Admission begins before the compliance date
Known discharge on or after the compliance date
Preauthorization should be requested with ICD-10 codes.
The code set used on the claim will be based on the discharge date, so the entire claim must be billed with ICD-10 codes.
ICD-10 – Are you ready? (cont.)
ICD-10 coding guidelines for preauthorizations and claims submission by type of service
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Type of Service Begins Ends Preauthorization Claim
Outpatient services
Service on or after the compliance date
NA
Preauthorization should be requested with ICD-10 codes.
Claim must be filed with ICD-10 codes.
Long-term outpatient services (such as physical therapy, radiation therapy, chemotherapy, etc.)
Services begin before the compliance date
Services end on or after the compliance date
Preauthorization obtained in ICD-9 will be valid for services rendered on or after the compliance date.
The claims for these services need to be separated and filed with the correct code set for the date(s) of service. Claims with both code sets, or mixed claims, will not be accepted.
ICD-10 – Are you ready? (cont.)
For the latest news on ICD-10 and links to resources,
visit the Anthem ICD-10 Updates webpage:
On the Anthem Provider Home page, look for the ICD-10 Updates link
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Questions? If you have any questions
about ICD-10, please email:
Anthem Medicaid Contact Information
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Provider Services: 1-855-661-2028
Member Services: 1-855-690-7784
Nurse Triage Line: 1-866-864-2544
Precertification phone: 1-855-661-2028
Precertification fax : 1-800-964-3627
Rx authorization phone: 1-855-661-2028
Rx authorization fax: 1-855-875-3627
Paper claim submission:
Kentucky Claims
Anthem Blue Cross and Blue Shield Medicaid
P.O. Box 61010
Virginia Beach, VA 23466-1010
Electronic claim submission:
Professional Payer ID: 00660
Institutional Payer ID: 00160
www.anthem.com/KYmedicaidDoc
Anthem Medicaid contact information
Provider Relations
E-Mail: [email protected]
Phone: 1-855-661-2027, Ext. 26771
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Questions?
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