Working with Anthem Subject Specific Webinar Series
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1 Working with Anthem Subject Specific Webinar Series E-Tools for Providers 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 E-Tools for Providers - Agenda Housekeeping & Announcements EDI Transactions Public Provider (commercial) Medicare Advantage Secure MyAnthem Provider Anthem Medicaid Provider Self Service Anthem Medicare Advantage Provider Self Service AIM Specialty Health Interactive Care Reviewer (ICR) Availity Demo Learn More 2
3 Working with Anthem Subject Specific Webinar Series Housekeeping & Announcements 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 3
4 E-Tools for Providers EDI Transactions Electronic Data Interchange (EDI) HIPAA complaint transactions 270/271 Eligibility Verification 275/276 Claim Status (batch and real-time) 837P and 837I Claim Submission Supports new claims Secondary (COB) claims Corrected claims 835 Remittance Advice (ERA) Electronic Funds Transfer (EFT) Enroll for EFT and EFT+ERA via CAQH Solutions EnrollHub 4
5 E-Tools for Providers EDI Transactions Electronic Data Interchange (EDI) continued Electronic Claim Payments What s in it for you? Payments through Electronic Funds Transfer (EFT) accelerates availability of funds. 835 Electronic Remittance Advice (ERA) is an industry consistent data format that may be integrated for auto posting with practice management systems saving time and eliminating human error. Paper Remittance Advice Suppression eliminates the need storage and archiving paper documents. These three elements combined can significantly increase back office efficiency for providers, regardless of practice size. Handout: Anthem EFT ERA Brochure 5
6 E-Tools for Providers EDI Transactions Electronic Data Interchange (EDI) continued EDI Support Companion Guides under the Documents menu Latest News Broadcast Messages, letters to trading partners and more under the Communications menu Implementation and Testing Support under the Services menu ERA only online registration and the ability to manage the suppression of paper remittance advice under the Register menu EDI Help Desk EDI Solutions at (800) E-Solutions EDI Solutions Team Live Chat 6
7 E-Tools for Providers Public Public Website Choose Providers under Other Anthem Websites Select Wisconsin from the drop down box and press Enter 7
8 E-Tools for Providers Public Provider Home Page Horizontal Menu Bar Touts Hyperlinks to more information 8
9 E-Tools for Providers Public Provider Home Page Touts MyAnthem SM and Availity Web Portals Link to logging into MyAnthem Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements Find a Doctor 9
10 E-Tools for Providers Public Provider Home Page Touts - Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements Policies are searchable by term and code Access link to other Blue Plan policies and requirements by entering the member s three-digit alpha prefix 10 10
11 E-Tools for Providers Public Provider Home Page Touts Find a Doctor Online Directories Find a doctor Search 11 11
12 E-Tools for Providers Public Provider Home Page Horizontal Menu Health and Wellness Plans & Benefits Communications Join Our Network 12 12
13 E-Tools for Providers Public Provider Home Page Hyperlinks Important Updates Self-Service & Support Our Plans and Benefits Medicaid Medicare Advantage Commercial Health and Wellness Communications & Updates 13 13
14 E-Tools for Providers Public Provider Home Page Too much to remember? Google Search Site Navigation Sheet Handout: Anthem Website Navigation Sheet 14 14
15 E-Tools for Providers Public Public Medicare Advantage Provider Website Choose Providers under Other Anthem Websites Select Medicare Solutions Choose Medicare Advantage under Plans and Benefits from the Provider Home Page 15 15
16 E-Tools for Providers Public Public Medicare Advantage Provider Website Important Medicare Advantage Updates Anthem Blue Cross and Blue Shield Plans and Benefits Medicare Advantage Provider Guides Member ID Card Samples Provider Forms Provider Training and FAQs Risk Adjustment Clinician Tools and Resources Medicare Advantage Reimbursement Policies ICD-10 Updates Webpage Quality Improvement Program Contact Us 16 16
17 E-Tools for Providers Secure Access via Availity My Payer Portals Choose Anthem Provider Portal to MyAnthem Provider Choose Anthem Medicaid Provider Self Service Choose Anthem Medicare Advantage Provider Self Service 17 17
18 E-Tools for Providers Secure MyAnthem Provider Reimbursement Policies Online Remittance Advice Copies Fee Schedule Inquiry Main Menu Remittance Fee Schedule Please choose an operation from the menu below: Remittance Inquiry Fee Schedule Inquiry 18 18
19 E-Tools for Providers Secure MyAnthem Provider Policies (reimbursement) Professional Facility 19 19
20 E-Tools for Providers Secure Anthem Medicaid Provider Self Service Claims* Precertification Eligibility* Medical Provider Education Reports Find a Doctor Other Services * Most functionality for claims and member eligibility is available exclusively through the Availity web portal
21 E-Tools for Providers Secure Anthem Medicare Advantage Provider Self Service Claims* Precertification Patient Information Provider Education * Functionality for claims and member eligibility is available exclusively through the Availity web portal
22 E-Tools for Providers Secure AIM Specialty Health (AIM) Who is AIM? Anthem, Inc. subsidiary Experienced in the management of radiology, cardiology, oncology, sleep medicine and specialty pharmacy benefits. Mission Improve the clinical appropriateness, safety and affordability of healthcare services
23 E-Tools for Providers Secure AIM Specialty Health (AIM) The services Imaging & Echocardiography Outpatient Radiation Therapy Cancer Care Quality Program Sleep Management Specialty Pharmacy The members Local and national Anthem commercial plans Some self-funded plans Anthem Medicare Advantage Copyright 2013 AIM Specialty Health, All Rights Reserved 23 23
24 E-Tools for Providers Secure AIM Specialty Health (AIM) Under Auths and Referrals Once you click I Agree, the system will open a new tab and log you seamlessly into the AIM Specialty Health precert site. Tip: Be sure you have allowed Pop-Ups within your Internet browser. Many functionalities within Availity operate by opening a separate screen
25 E-Tools for Providers Secure AIM Specialty Health (AIM) Log on The HIPAA disclaimer must be accepted before you will be allowed further into the secure AIM Portal functionality. Copyright 2013 AIM Specialty Health, All Rights Reserved 25 25
26 E-Tools for Providers Secure AIM Specialty Health (AIM) Search by Member Name and Date of Birth The AIM Specialty Health functionality now offers you the ability to search for a member by Name & Date of Birth Helpful when the member ID is incorrect or not available. The search requires a minimum of 2 letters in each field. Copyright 2013 AIM Specialty Health, All Rights Reserved 26 26
27 E-Tools for Providers Secure AIM Specialty Health (AIM) Next Generation Solutions Advancing our technologies for improved efficiency Enhancements begin August 7 th Redesigned workflow allows you to be more effective: o Clinical data entry process is now better tailored to your patient's diagnosis o Requests may be reviewed and edited before submission o Clear, quick feedback when requested procedure does not meet clinical criteria on initial review o Streamlined data collection better informs you and AIM clinicians, making peer-to-peer review more valuable o Order summaries can be sent to you and others, a more convenient way to access your requests and inform others Copyright 2013 AIM Specialty Health, All Rights Reserved 27 27
28 E-Tools for Providers Secure AIM Specialty Health (AIM) Next Generation Solutions Advancing our technologies for improved efficiency What s New Intake workflow for cardiology, head and neck, and bone density exams including, but not limited to: o Myocardial Perfusion Imaging (MPI) o Cardiac MRI o Resting Echocardiogram o Stress Echocardiogram o CT Head o CT Neck o CT Sinus o MRI Head Copyright 2013 AIM Specialty Health, All Rights Reserved 28 28
29 E-Tools for Providers Secure AIM Specialty Health (AIM) Next Generation Solutions Advancing our technologies for improved efficiency What s Not No changes to the AIM clinical guidelines or other clinical criteria used to review requests AIM clinical support team remains available for peer to peer provider consultation as before No changes to Sleep, Specialty Drugs, Radiation Therapy, or Medical Oncology order request processes at this time No intake changes at this time for other diagnostic imaging modalities such as: o Exams of the abdomen, breast, or pelvis o PET scans Learn More Copyright 2013 AIM Specialty Health, All Rights Reserved 29 29
30 E-Tools for Providers 30 30
31 E-Tools for Providers Interactive Care Reviewer (ICR) Currently available for Inpatient, Outpatient and Behavioral Health precertification requests for services not medically managed by AIM Specialty Health SM For local Anthem members* Accessed through Availity Register for ICR Training on the Provider Home Page *Note: ICR is not currently available for Medicare Advantage, Medicaid, Federal Employee Program (FEP), BlueCard, and some National Account members; requests involving transplant services; or services administered by AIM Specialty Health For these requests, follow the same precertification process that you use today
32 E-Tools for Providers Interactive Care Reviewer (ICR) 32 32
33 E-Tools for Providers Availity Real-time request and response in a consistent format for multiple payers with a single sign-on Eligibility, benefits, claim status inquiry and more for any Blue, Federal Employee Plan (FEP), Anthem Medicaid or Medicare Advantage member. No cost to providers Availity is an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on 33 33
34 E-Tools for Providers Availity 34 34
35 E-Tools for Providers Learn More Wisconsin (commercial) Public Provider Website Home Page Provider Education Page Wisconsin Medicare Advantage Public Provider Website Interactive Care Reviewer Webinar Registration Link Availity New Eligibility and Benefit Inquiry Training Registration Link 35 35
36 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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