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Northern Colorado IPA: Office Manager’s meeting, August 2012.
Slides accompanying Anthem Blue Cross Blue Shield Presentation "What you need to know about...
Anthem’s HMOSelect product for your office
Anthem’s PCP Incentive Program"

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Omm201209slides

  1. 1. Northern Colorado IPA: OfficeManager’s meeting, August 2012Presented by:Audra Ricke, Zanetta Jackson and JackieFerguson, Anthem Blue Cross and Blue Shield
  2. 2. Anthem Blue Cross and Blue Shield (Anthem):AgendaIntroductionsHMOSelectAnthem Quality Insights (AQI)AvailityeUpdatesWrap Up Northern Colorado IPA Office Managers Meeting August 2012 2
  3. 3. Introductions
  4. 4. Provider Engagement and Contracting:IntroductionsJackie Ferguson, Network Education and CommunicationZanetta Jackson, Regional Contract ManagerAudra Ricke, Regional Contract Manager Northern Colorado IPA Office Managers Meeting August 2012 4
  5. 5. HMOSelectTM
  6. 6. HMOSelectOverview ▪ In 2005, HMO Colorado launched the HMOSelect product line in the Denver metro area, and in 2006 we expanded to Colorado Springs. ▪ HMOSelect plans look just like our HMO Colorado BlueAdvantage plans, with one critical difference: The HMOSelect network is limited to a select number of participating physicians, hospitals and ancillary providers. ▪ On July 1, 2012 we are expanded to Northern Colorado! Northern Colorado IPA Office Managers Meeting August 2012 6
  7. 7. HMOSelect expanded networkEffective July 1, 2012 includes the following: ▪ Hospitals • Poudre Valley Hospital • Medical Center of the Rockies ▪ Physicians • Poudre Valley Medical Group physicians and select groups in surrounding areas. ▪ Detailed professional and ancillary HMOSelect provider directory is available at anthem.com. • NOTE: separate option to select from (different from HMO) Northern Colorado IPA Office Managers Meeting August 2012 7
  8. 8. HMOSelect online Provider DirectoryFind a Doctor  Go to anthem.com, select Provider link in lower right corner.  Select Colorado from drop down list and enter  From the Provider Home page, select the “Find a Doctor” tout (blue box in lower left corner of page) Northern Colorado IPA Office Managers Meeting August 2012 8
  9. 9. HMOSelect online Provider Directory Step 1: select “Insurance Plan Information” Step 2: select “Browse and select by plan” Step 3: select “HMO” Step 4: select “HMOSelect” Northern Colorado IPA Office Managers Meeting August 2012 9
  10. 10. HMOSelect vs. HMO PlansThe ONLY difference between the plans is the LIMITEDNETWORK. ▪ Just like HMO members, HMOSelect members do not have out- of-network benefits. • Note: Providers in the HMO Colorado network who are NOT in the HMOSelect network are considered out-of-network for HMOSelect members. ▪ Providers must have a separate participating provider agreement • Participating provider contracts refer to HMOSelect as “the limited network HMO product (EPO).” Northern Colorado IPA Office Managers Meeting August 2012 10
  11. 11. HMOSelect membershipGroups eligible for HMOSelect ▪ The HMOSelect network is not available to BlueCard® and FEP members. ▪ Guest Membership would utilize HMO product, not HMOSelectIdentifying HMOSelect members ▪ Separate alpha prefix for HMOSelect members to help differentiate from HMO Colorado BlueAdvantage members. • XFB, XFC = HMOSelect Northern Colorado IPA Office Managers Meeting August 2012 11
  12. 12. HMOSelect sample copy of health plan ID Card Northern Colorado IPA Office Managers Meeting August 2012 12
  13. 13. HMOSelect operational proceduresSame as for HMO: ▪ Authorizations ▪ Customer service phone numbers ▪ Claims addresses ▪ EOPs • HMOSelect claims and HMO Colorado claims will appear under separate headings. ▪ Adjustments • Use the Claim Action Request Form. ▪ Appeals • Use the Provider Dispute Resolution Form. Northern Colorado IPA Office Managers Meeting August 2012 13
  14. 14. HMOSelect Imaging and Specialty Drug RequestsManaged by AIM Specialty Health (AIM) ▪ Authorizations can be obtained online from AIM through: • AIM’s ProviderPortalSM - www.aimspecialtyhealth.com • Anthem’s ProviderAccess, from the Auths & Referrals tab, select the Imaging and Specialty Drug Requests link - www.anthem.com • Availity, under Auths & Referrals, select the Imaging and Specialty Rx Precert link - www.availity.com • Or, by phone at 877-291-0366 ▪ The HMOSelect network has a limited number of sites. • NOTE: for HMOSelect in northern Colorado, imaging services must be performed at Poudre Valley Hospital, Medical Center of the Rockies or one of their owned free standing facilities. Northern Colorado IPA Office Managers Meeting August 2012 14
  15. 15. Anthem Quality-In-sights®
  16. 16. Primary Care Incentive Program:Anthem Quality-In-sights® (AQI)Program overview for Physicians  Rewards performance based on nationally endorsed industry standard measures of quality as well as technology adoption, applicable external recognitions, and appropriate generic drug utilization.  The clinical quality measures have been derived from sources such as: • HEDIS (The Health Plan Employer Data and Information Set) • National Quality Forum (NQF) • Ambulatory Care Quality Alliance (AQA)  The methods used are consistent with those recommended by National Committee for Quality Assurance (NCQA) and reflect the most current standards on measuring physician quality of care. • HEDIS reporting is the standard for data collection and performance measurement of managed care organizations.  50% of PCPs were in the program for measurement period November 2009 - October 2010  100% of PCPs now participate in the program as of January 1, 2011 Northern Colorado IPA Office Managers Meeting August 2012 16
  17. 17. Primary Care Incentive Program:Anthem Quality-In-sights® (AQI)Surveys for the 2012 AQI Primary Care Incentive Program: ▪ Due no later than January 15, 2013 ▪ A survey is required upon completion of the reporting period for 2012 which ends December 31, 2012. ▪ The survey is completed once for all group office practice locations under a single TIN. ▪ Surveys that need to be completed and returned are available online. • Go to anthem.com, and select Provider link in upper left corner. • Select Colorado from drop down list and enter. • From Health & Wellness tab, select the Quality link, then the link titled “Quality-In-Sights®”, or - log into the Provider Online Interactive Tool (POIT) through our secure provider portal, ProviderAccess. - Your ProviderAccess Account Administrator must grant you access to view POIT. Northern Colorado IPA Office Managers Meeting August 2012 17
  18. 18. Primary Care Incentive Program:Anthem Quality-In-sights® (AQI)Surveys for the 2012 AQI Program: continued ▪ This is a required survey for the External Physician Recognition, Clinical Improvement, and Care Systems components and may satisfy certain requirements that will assist you in achieving established goals. ▪ The easiest way to submit this information is through POIT. • Just log on to POIT no later than January 15, 2013, enter your information and you’re done! • You can also submit your survey to Anthem via e-mail prrprogramsnv@wellpoint.com, or fax: 303-764-7292 or mail to the following address: •Anthem Blue Cross and Blue Shield •Quality-In-Sights Program •700 Broadway •Mail No: CO0105-0527 •Denver, CO 80273 Northern Colorado IPA Office Managers Meeting August 2012 18
  19. 19. Provider Portal ConnectivityOptions
  20. 20. Provider Portal Connectivity Options:Agenda ProviderAccess and Availity FAQ’s regarding ProviderAccess and Availity Availity contact information Availity demo Availity interest form Northern Colorado IPA Office Managers Meeting August 2012 20
  21. 21. Provider Portal Connectivity Options:ProviderAccess and AvailityProviderAccess, Anthem’s secure provider portal  Available for Anthem membership only • Includes Local Plan, BlueCard, and Federal Employee Program (FEP) membersAvaility, multi-payer portal  Available for Anthem membership starting April 23, 2012 • Includes Local Plan, BlueCard, and Federal Employee Program (FEP) members  Access other payers in Colorado/Nevada along with Anthem information on one portal Northern Colorado IPA Office Managers Meeting August 2012 21
  22. 22. Provider Portal Connectivity Options:FAQ’s regarding ProviderAccess and AvailityQ: Does this mean ProviderAccess is going away?A: Yes, eventually, but not until all existing functionality has been made available on Availity. The transactional functionality, i.e. E&B, claims inquiry will be migrated first, which means rolling out the core Availity functionality and then disabling the comparable links on Provider Access at providers begin to migrate. We expect this to occur by the first part of 2013. Separately, we are working with Availity to build an “app store” type of functionality through which proprietary functionality, fee schedules can be made available. The combination of the transactional functionality and the proprietary applications will allow us to fully sunset the legacy portals. The app store platform is currently under development with Availity.Q: What is this going to cost?A: Nothing! Portal transactions through Availity – Claims, Eligibility & Benefits, Imaging and Specialty RX Pre-Certification, Clinical Messaging, CarePofile and Secure Messaging – are free of charge to our participating providers.Q: If I change to a user’s access on one system, will it automatically change on the other?A: No. Site Administrators will need to facilitate user access in each system separately.Q: What if I prefer not to use Availity?A: We believe once you start using Availity, you will realize the many advantages and benefits – so give it a try! Northern Colorado IPA Office Managers Meeting August 2012 22
  23. 23. Provider Portal Connectivity Options:Availity OverviewAvaility is a leading health information network offering a variety ofonline business and clinical services to users, ranging from healthcare providers to health plans and technology partners. Availityoptimizes information exchange between multiple health carestakeholders through a single, secure network.Availity’s multi-payer portal allows providers to reference patientinformation from multiple insurance companies from the samewebsite. Northern Colorado IPA Office Managers Meeting August 2012 23
  24. 24. Provider Portal Connectivity Options:Why You Should Use Availity Payer A Payer B  Multi-payer access  Accurate, real-time Payer H Payer C information  Common look and feel; easy to use Payer G Payer D  Secure network  No cost to providers for health plan Payer F Payer E transactions Northern Colorado IPA Office Managers Meeting August 2012 24
  25. 25. Provider Portal Connectivity Options:Availity Products and Services Overview Business Solutions Health plan sponsored tools—reduce manual inquiries and support mass adoption for an Clinical Solutions accelerated ROI. Clinical tools help support collaborative, Batch/Clearinghouse health plan-sponsored programs for • Claims improving patient care delivery and • Remittance Advice quality outcomes. Real-time • Eligibility & Benefits Health Record • Claim Status • CareProfile® • Referrals/Authorizations • Claim Submission Electronic Prescribing • CarePrescribe® Card Swipe • CareRead® Patient Responsibility • CareCost EstimatorSM Payment Solution • CareCollect® Northern Colorado IPA Office Managers Meeting August 2012 25
  26. 26. Provider Portal Connectivity Options:Availity registration for Anthem ServicesRegistering an Availity User forAnthem Services1. Log in to Availity and click My Account | Anthem Services Registration. If prompted, select your organization next.2. In the Display field, click Non-Registered Users.3. Enter the user’s ProviderAccess Log-On ID in the field provided. • To enable the Register button, enter one or more user ProviderAccess IDs • If the user does not have a ProviderAccess Log-On ID, contact the Account Administrator to obtain one, and then return to this page to register the user.4. Click Register.5. Note that the User(s) Registered page displays. • If registration is successful, the user(s) can begin using the services immediately. • If an error message displays, the registration or change was not successful for that user. Review the message and verify the information you entered. Make note of the Transaction ID if you need to contact Availity Client Services for assistance. Please note that the user’s first name, last name, and ProviderAccess Log-On ID in Availity must match exactly with how the user is registered with Anthem. Northern Colorado IPA Office Managers Meeting August 2012 26
  27. 27. Provider Portal Connectivity Options:Secure Messaging – Anthem From the Claims Detail page:  Send a Secure Message to Anthem regarding a question on a claim. – Available for Local, BlueCard and FEP claims inquiries – Note: the PAA must go to grant access for the User to view Secure Messaging Northern Colorado IPA Office Managers Meeting August 2012 27
  28. 28. Provider Portal Connectivity Options:Secure Messaging – AnthemAvaility Claims Status Inquiry page Northern Colorado IPA Office Managers Meeting August 2012 28
  29. 29. Provider Portal Connectivity Options:Secure Messaging – AnthemAvaility Claims Status Inquiry page Northern Colorado IPA Office Managers Meeting August 2012 29
  30. 30. Provider Portal Connectivity Options:Secure Messaging – AnthemAvaility Claims Status Inquiry Results Northern Colorado IPA Office Managers Meeting August 2012 30
  31. 31. Provider Portal Connectivity Options:Secure Messaging – AnthemAvaility Claims Management Northern Colorado IPA Office Managers Meeting August 2012 31
  32. 32. Provider Portal Connectivity Options:Secure Messaging – AnthemSecure Message Disclaimer Northern Colorado IPA Office Managers Meeting August 2012 32
  33. 33. Provider Portal Connectivity Options:Secure Messaging – AnthemSend/Compose Northern Colorado IPA Office Managers Meeting August 2012 33
  34. 34. Provider Portal Connectivity Options:Secure Messaging – AnthemSend Message Confirmation Northern Colorado IPA Office Managers Meeting August 2012 34
  35. 35. Provider Portal Connectivity Options:Secure Messaging – Anthem For Secure Messages to and from Anthem, click Claims Management, then click Secure Messaging from the drop down menu. Northern Colorado IPA Office Managers Meeting August 2012 35
  36. 36. Provider Portal Connectivity Options:Secure Messaging – AnthemSecure Provider Message Inbox Northern Colorado IPA Office Managers Meeting August 2012 36
  37. 37. Provider Portal Connectivity Options:Availity Free Training WebinarsAvaility offers free training webinars (live and on-demand) eachmonth. Training is available for all user types, and across a broadrange of topics, including:  EDI training  Auths & Referrals  Availity 101  E&B Inquiry  CareCollect®  PAA training  CareCalc®  …and many more Northern Colorado IPA Office Managers Meeting August 2012 37
  38. 38. Provider Portal Connectivity Options:Availity Online Demo – go to www.availity.com Providers can view a demo prior to registering for Availity to see the functionality available online. • Go to www.availity.com. • Select the Demo tab, then select the Explore Demonstration button. • This will route you to the Availity Log In page. You do not need to have a user name and password, just select the Log In button. • Select Colorado from the drop down list, and enter. • Next, select the links under the left side of the page to see an interactive demonstration of that specific functionality. • Select the plus sign “+” next to the topic you’d like to view to see a full list of demonstrations. Northern Colorado IPA Office Managers Meeting August 2012 38
  39. 39. Provider Portal Connectivity Options:Register Online• Go to www.availity.com See handout in your packet titled “Registering a Provider• Click Register Now Organization”• Follow the online instructions Northern Colorado IPA Office Managers Meeting August 2012 39
  40. 40. Provider Portal Connectivity Options:Availity Contact Information 800.AVAILITY (800.282.4548) www.availity.com Crystal D. Roberts Market Development Representative, Availity 972.383.6470 (o) | 214.629.8066 (c) | 972.385.0447(f) croberts@availity.comIf you would like more information regarding Availity, see handout in Your Anthem Provider Engagement and your packet titled Contracting Representative can answer “Availity Interest Form” general questions. Northern Colorado IPA Office Managers Meeting August 2012 40
  41. 41. Anthem Network eUpdateSign up today!
  42. 42. Anthem Network eUpdate• Are you registered for Anthem Network eUpdate yet? ▪ Receive all Anthem Provider Communications via email: • Provider Communications • Provider Newsletters • Provider Bulletins ▪ Emails are cleaner, clearer and easier to read than fax communications ▪ Emails will also help you use less paper and fax toner, which can help with administrative costs• Register online: ▪ From anthem.com > Providers > Colorado > enter > Anthem Network eUpdate link ▪ Enter required fields and be registered IMMEDIATELY! ▪ Sign up with us TODAY!
  43. 43. Anthem Network eUpdate: Registration
  44. 44. Anthem Network eUpdateAre you receiving duplicates? ▪ To avoid duplications, once you have registered, please send an email to Jackie.Ferguson@anthem.com with a subject line “REMOVE from Fax distribution list, already signed up for Anthem Network eUpdate”, or by phone at 303-831-5846 (toll free 1-800- 570-8105, ext 5846). ▪ Include Provider Name and fax number to be removed
  45. 45. Wrap Up
  46. 46. Wrap UpRemaining QuestionsThank you! Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. 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. Northern Colorado IPA Office Managers Meeting August 2012 46

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