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Northern Colorado IPA: Office Manager’s meeting, August 2012 Presented by: Audra Ricke, Zanetta Jackson and Jackie Ferguson, Anthem Blue Cross and Blue Shield
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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"
Transcript of Omm201209slides
Northern Colorado IPA: Office Manager’s meeting, August 2012
Presented by:
Audra Ricke, Zanetta Jackson and Jackie
Ferguson, Anthem Blue Cross and Blue Shield
Anthem Blue Cross and Blue Shield (Anthem):
Agenda
Introductions
HMOSelect
Anthem Quality Insights (AQI)
Availity
eUpdates
Wrap Up
2 Northern Colorado IPA Office Managers Meeting August 2012
Introductions
Provider Engagement and Contracting:
Introductions
Jackie Ferguson, Network Education and Communication
Zanetta Jackson, Regional Contract Manager
Audra Ricke, Regional Contract Manager
Northern Colorado IPA Office Managers Meeting August 2012 4
HMOSelectTM
HMOSelect
Overview
▪ 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
HMOSelect expanded network
Effective 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
HMOSelect online Provider Directory
Northern Colorado IPA Office Managers Meeting August 2012 8
Find 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)
HMOSelect online Provider Directory
Northern Colorado IPA Office Managers Meeting August 2012 9
Step 1: select “Insurance Plan
Information”
Step 2: select “Browse and
select by plan”
Step 3: select “HMO”
Step 4: select “HMOSelect”
HMOSelect vs. HMO Plans
The ONLY difference between the plans is the LIMITED
NETWORK.
▪ 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
HMOSelect membership
Groups eligible for HMOSelect
▪ The HMOSelect network is not available to BlueCard® and FEP
members.
▪ Guest Membership would utilize HMO product, not HMOSelect
Identifying 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
HMOSelect sample copy of health plan ID Card
Northern Colorado IPA Office Managers Meeting August 2012 12
HMOSelect operational procedures
Same 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
HMOSelect Imaging and Specialty Drug Requests
Managed 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
Anthem Quality-In-sights®
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
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
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
[email protected], 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
Provider Portal Connectivity Options
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
Provider Portal Connectivity Options:
ProviderAccess and Availity
ProviderAccess, Anthem’s secure provider portal
Available for Anthem membership only
• Includes Local Plan, BlueCard, and Federal Employee Program
(FEP) members
Availity, 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
Provider Portal Connectivity Options:
FAQ’s regarding ProviderAccess and Availity Q: 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
Provider Portal Connectivity Options:
Availity Overview
Availity is a leading health information network offering a variety of
online business and clinical services to users, ranging from health
care providers to health plans and technology partners. Availity
optimizes information exchange between multiple health care
stakeholders through a single, secure network.
Availity’s multi-payer portal allows providers to reference patient
information from multiple insurance companies from the same
website.
Northern Colorado IPA Office Managers Meeting August 2012 23
Provider Portal Connectivity Options:
Why You Should Use Availity
Northern Colorado IPA Office Managers Meeting August 2012
Payer A Payer B
Payer H Payer C
Payer D Payer G
Payer F
Payer E
Multi-payer access
Accurate, real-time
information
Common look and feel;
easy to use
Secure network
No cost to providers for
health plan
transactions
24
Provider Portal Connectivity Options:
Availity Products and Services Overview
Northern Colorado IPA Office Managers Meeting August 2012
Clinical Solutions
Clinical tools help support collaborative,
health plan-sponsored programs for
improving patient care delivery and
quality outcomes.
Health Record
• CareProfile®
Electronic Prescribing
• CarePrescribe®
Business Solutions
Health plan sponsored tools—reduce manual
inquiries and support mass adoption for an
accelerated ROI.
Batch/Clearinghouse
• Claims
• Remittance Advice
Real-time
• Eligibility & Benefits
• Claim Status
• Referrals/Authorizations
• Claim Submission
Card Swipe
• CareRead®
Patient Responsibility
• CareCost EstimatorSM
Payment Solution
• CareCollect®
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Provider Portal Connectivity Options:
Availity registration for Anthem Services
Northern Colorado IPA Office Managers Meeting August 2012 26
Registering an Availity User for
Anthem Services
1. 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.
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 27
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
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 28
Availity Claims Status Inquiry page
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 29
Availity Claims Status Inquiry page
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 30
Availity Claims Status Inquiry Results
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 31
Availity Claims Management
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 32
Secure Message Disclaimer
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 33
Send/Compose
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 34
Send Message Confirmation
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 35
For Secure Messages to and from
Anthem, click Claims Management,
then click Secure Messaging from the
drop down menu.
Provider Portal Connectivity Options:
Secure Messaging – Anthem
Northern Colorado IPA Office Managers Meeting August 2012 36
Secure Provider Message Inbox
Provider Portal Connectivity Options:
Availity Free Training Webinars
Availity offers free training webinars (live and on-demand) each
month. Training is available for all user types, and across a broad
range 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
Provider Portal Connectivity Options:
Availity Online Demo – go to www.availity.com
Northern Colorado IPA Office Managers Meeting August 2012
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.
38
Provider Portal Connectivity Options:
Register Online
Northern Colorado IPA Office Managers Meeting August 2012
• Go to www.availity.com
• Click Register Now
• Follow the online instructions
See handout in your packet titled
“Registering a Provider
Organization”
39
Provider Portal Connectivity Options:
Availity Contact Information
Crystal D. Roberts
Market Development Representative, Availity
972.383.6470 (o) | 214.629.8066 (c) | 972.385.0447(f)
800.AVAILITY (800.282.4548)
www.availity.com
Your Anthem Provider Engagement and
Contracting Representative can answer
general questions.
Northern Colorado IPA Office Managers Meeting August 2012
If you would like more information
regarding Availity, see handout in
your packet titled
“Availity Interest Form”
40
Anthem Network eUpdate
Sign up today!
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!
Anthem Network eUpdate: Registration
Anthem Network eUpdate
Are you receiving duplicates?
▪ To avoid duplications, once you have registered, please send an
email to [email protected] 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
Wrap Up
Wrap Up
Remaining Questions
Thank 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.
46 Northern Colorado IPA Office Managers Meeting August 2012
