Anthem Updates for RMGMA

Thursday, November 13, 2014

Eric Walker Director Network Management

Provider Solutions eric.walker@anthem.com

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AGENDA

Health Insurance Exchange

Medicaid

Medicare/Medicaid Duals

Point of Care ~ Availity

Contacting Anthem

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Health Insurance Exchange

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Health Insurance Exchange (HIX) • Open Enrollment is 11/15/2014 - 2/15/15.

(see https://www.healthcare.gov/marketplace-deadlines for more information)

• Patients who kept their plans with NO CHANGES back when ACA originally first became law (3/23/2010) and are termed, “grandfathered”, can continue with those plans; however, providers and patients need to remember that those plans did not have mandated preventive services at $0 copay.

• Those “non-grandfathered” plans where patients were given early renewal status to extend their existing non-ACA coverage to 12/1/14 have been given an extra month’s extension to 1/1/15 by the BOI. Come 1/1/15, there will no-longer be “non-grandfathered” plans.

• For these above, letters have already gone out to Small Groups (SG); letters to Individuals were mailed 10/6 - 10/29/14.

• Anthem’s premium increase for Individual plans from 2014 to 2015 averages 3%.

• Penalties for no coverage will be assessed at TAX TIME.

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HIX Information (continued)

• The 90-day grace period for premiums is still only applicable to those with premium subsidies.

• Subsidies will be re-determined in 2015; patients must check the box on the application to confirm income; otherwise, subsidy may be lost.

• All 2014 ACA plans will see changes due to government mandates (Federal and State) and also some changes for Anthem’s experience. • Small Group will begin domestic partner coverage effective 1/1/15.

(ON and OFF Exchange; see healthcare.gov for definition).

• Drug formularies will all be 4-Tier (ON and OFF Exchange, Individual and Small Group).

• Breast cancer risk-reducing meds added to ACA Preventive Care.

• The Bariatric surgery rider will be gone 1/1/15 (Individual and Small Group).

• Pediatric dental will be embedded in all plans 1/1/15 (even for those with no children).

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Changes to Naming Convention

Plan names will include: • Master brand • Metal level • On-Exchange indicator (X) • Network Type (for POS plans only;

HMO will not appear in the name.) • Deductible and coinsurance (for

HSA plans only the coinsurance will be included)

• American Indian (AI) • Subsidy (S04, S05 or S06) • HSA Indicator

Plan names changing for ACA plans • All 2015 plans will follow the new naming convention • Multi-State Plan (MSP) names will stay the same.

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Pathway X Tiered Hospital (ON Exchange) Non-Par Hospitals

Hospital City/Town

1 Bon Secours Memorial Regional Medical Center Mechanicsville

2 Bon Secours Richmond Community Hospital Richmond

3 Bon Secours St. Francis Medical Center Midlothian

4 Bon Secours St. Mary’s Hospital Richmond

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Pathway X Tiered (ON Exchange) and Pathway Tiered (OFF Exchange) TIER 2 Hospitals (higher member cost share)

Hospitals City/Town

1 Mary Washington Hospital Fredericksburg

2 Medical College of Virginia Richmond

3 Carilion Medical Center Tier 1 Roanoke

4 University of Virginia Tier 1 Charlottesville

5 Mary Immaculate Tier 1 Newport News

6 Bon Secours Maryview Hospital Tier 1 Portsmouth

7 Bon Secours DePaul Hospital Tier 1 Norfolk

If not “Non-Par” or Tier 2, a hospital is Tier 1.

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2014 Anthem HIX Plans/Products

NOTE: The HIX Provider Call Center takes calls for all HIX products. When identifying your provider’s HIX network status, please give the individual NPI# unless you are a group exempt-billable specialty, i.e. anesthesiology, etc.

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2015 Anthem HIX Plans/Products

Two new prefixes, YTZ and XTO; Revised chart is still ….

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HIX Info Online (under COMMUNICATIONS tab)

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Medicaid (HealthKeepers Plus)

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Contacting Anthem Medicaid

Main Telephone #: (800) 901-0020

Central Region Network Relations Representative Shanequa Abney

Shanequa.Abney@anthem.com 804-354-3684

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Medicare/Medicaid Duals (CCC)

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Medicare / Medicaid DUAL Eligibles • CMS and DMAS implemented a fully integrated dual demonstration

program called “Commonwealth Coordinated Care”, to better serve approximately 78,000 individuals in VA who are eligible for both Medicare and Medicaid (dual eligibles- also referred to as MMP).

• Dual coverage eligibility is not new– What is new is this 3-year “demonstration” which began on April 1, 2014, and operates in five (5) VA regions, i.e. Northern, Central, Tidewater, Western/Charlottesville, and Roanoke.

• Anthem was selected for all five regions, along with VA Premier and Humana.

• As this is Medicare driven, providers who accept Medicare today should enroll (providers do not have to be with DMAS or HK+ to be in Duals)

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MMP (continued)

• Our Duals product includes the selection or assignment of a PCP but there is no formal PCP referral requirement; however, there is a requirement for precertification of certain services, e.g. hospital admissions, etc.

• Our Duals product includes the use of LabCorp and also the same fee-for-service physician office lab (POL) lists that we use today for regular HK and HK+ members. These lists are found in your provider agreement and also online under Answers @ Anthem. (see next slide)

• Anthem began our network development efforts via a mailing back in July 2013 for an original effective date of January 2014; however, that date moved to April 2014 and some providers never joined.

• Anthem’s statewide Duals (MMP) enrollment is currently at 10,414.

• The prefix for this plan is YRC and the Provider Call Center # is (855) 817-6788.

• If your provider(s) wishes to join now, please contact your network manager for the Add-a-Plan process.

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Physician Office Lab lists (online)

NOTE: Any Virginia Anthem product with “HealthKeepers, Inc.” on the ID card is subject to using LabCorp or these POL lists for office-based lab tests.

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Availity

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Anthem’s SECURE Online Provider Portals

*Coming December 12, 2014*

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Availity • Medical management functionality, reports including remittances, and

access to prior electronic 151s will remain on Point of Care. HOWEVER, access to these functions will need to be via single sign-on through the Availity Web Portal.

• Secure Messaging functionality on the Availity Web Portal will replace the Anthem electronic 151 inquiry.

• Go to www.availity.com. Click on "Get Started" under Register now for the Availity Web Portal, then complete the online registration wizard. You will receive an e-mail from Availity with a temporary password and next steps. If you need further assistance from Availity, please contact

Client Services at 1-800-AVAILITY (282-4548).

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Contacting Anthem

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Provider Network Manager Territory Listing

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Contacting Anthem

Main Telephone #: (800) 533-1120

EDI Solutions HELP DESK: Phone: (800) 470-9630 ; Fax (804) 354-2529

E-mail: edi.ent.support@anthem.com

LiveChat: anthem.com/edi

Mail / Correspondence: P. O. Box 27401, Richmond, VA 23279

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Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc., are 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.

Thank You for inviting me to speak today and for your

continued support of Anthem.