eAnthem Online Provider Services Site Enhancement Update September 17, 2004
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Anthem Online Provider Services – Your Direct Connection! Important Site Enhancement Update September 17, 2004 We are pleased to share some good news regarding changes to the Anthem Online Provider Services Web site, based on your feedback. Screen prints of sample results are included. W Coverage and Benefit Results - Navigation Improvements for Members whose enrollment information resides on our local Anthem Blue Cross and Blue Shield system in the East Region (Connecticut, Maine and New Hampshire) – The links to additional Coverage and Benefits Detail Results screens have been upgraded to buttons ([PCP History], [Services/Therapies], [More Coverage], and [Coverage History]). These buttons will be orange when additional information is available; otherwise the button will be gray. A new browser window will open when using these buttons. Click on the [Close] button to return to the Coverage and Benefits Detail page. § §
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The “More Member Info…” and “Summary Info…” links on the Multi-Member Results screens have been replaced with a [More Info] button located beneath the results for each member returned. The magnifying glass links on the full Coverage and Benefits Detail section have been replaced with buttons and have been relocated to improve navigation. For example, [Coverage History] is now located beneath the “Most Recent Coverage” box. “Managed Care Information”, formerly available at the bottom of the full Coverage and Benefits Detail screen, is now available via the [More Coverage] button.
W Additional Institutional Coverage and Benefit Detail for Members whose enrollment information resides on our local Anthem Blue Cross and Blue Shield system in the East Region (Connecticut, Maine and New Hampshire) – We have tripled the institutional benefit details available for these members (this includes prefixes beginning with XG, XV, YG, CTN, CTP, MEP, MEN, NHN or NHP)! Basic cost share and benefit information is now available for the most recent coverage period for the following facilities: Hospitals, Surgical Centers, Skilled Nursing Facilities and Home Health Agencies. See our online HELP for more information. §
Institutions: Hospital, Surgical Center or Radiology Facility Benefit Description Location on AOPS Emergency Room (in and out-of-network) Inpatient / Outpatient Surgery or Ambulatory Surgery Inpatient Hospital (in and out-of-network) Outpatient Hospital (in and out-of-network) Physical Rehabilitation (Hospital) Radiology (i.e.: CAT Scan) Urgent Care (in and out-of-network)
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Other Facilities: Skilled Nursing Facility or Home Health Care Agency Benefit Description Location on AOPS Home Health Agency Visits Skilled Nursing Facility
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Coverage and Benefits Detail : “Copayments” and/or “Coinsurance” Coverage and Benefits Detail : “Copayments”, “Deductibles” and/or “Coinsurance” Coverage and Benefits Detail : “Copayments”, “Deductibles” and/or “Coinsurance” Coverage and Benefits Detail : “Copayments”, “Deductibles” and/or “Coinsurance” Coverage and Benefits Detail : [More Coverage] – “Facility” Coverage and Benefits Detail : [More Coverage] – “Radiology” Coverage and Benefits Detail : “Copayments”
Coverage and Benefits Detail : [More Coverage] – “Facility” Coverage and Benefits Detail : [More Coverage] – “Facility”
Note - The cost shares currently available online represent Anthem Blue Cross and Blue Shield’s standard benefits that may vary by plan and product. This does not represent a complete listing of health benefits and level of coverage. It may not include variations such as those based on procedure, patient age, visit number, diagnosis and services that do not apply cost shares.
P04103 Anthem Blue Cross and Blue Shield is the trade name for the following: In Connecticut: Anthem Health Plans, Inc. In Maine: Anthem Health Plans of Maine, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. Independent licensees of the Blue Cross and Blue Shield Association. ® Registered marks of the Blue Cross and Blue Shield Association
W Additional Professional Coverage and Benefit Detail for Members whose enrollment information resides on our local Anthem Blue Cross and Blue Shield system in the East Region (Connecticut, Maine and New Hampshire) – We have increased the amount of professional benefit detail available for these members (this includes prefixes beginning with XG, XV, YG, CTN, CTP, MEP, MEN, NHN or NHP). Our July 9, 2004 site enhancement included the display of therapy type (Physical Therapy, Occupational Therapy, Speech Therapy or Chiropractic), copay amount, maximum amount and visit limit. Cost share and benefit information is now available for the most recent coverage period for the following additional services: allergy, behavioral health, durable medical equipment (DME), family planning, nutritional counseling, preventative care and vision. See our online HELP for more information. §
Professional Benefits: Behavioral Health and Family Planning Benefit Description Location on AOPS Behavioral Health Family Planning
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Additional Services: allergy, durable medical equipment, nutritional counseling, preventative care and vision. When applicable, visits used for these services may be available via the “Visit History” link. Benefit Description Location on AOPS Allergy Durable Medical Equipment (DME) Nutritional Counseling Preventative Care Vision
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Coverage and Benefits Detail : [More Coverage] – “Behavioral Health” Coverage and Benefits Detail : [More Coverage] – “Family Planning”
Coverage and Benefits Detail : [Services/Therapies] – “Services” Coverage and Benefits Detail : [Services/Therapies] – “Services” Coverage and Benefits Detail : [Services/Therapies] – “Services” Coverage and Benefits Detail : [Services/Therapies] – “Services” Coverage and Benefits Detail : [Services/Therapies] – “Services”
Note - The cost shares currently available online represent Anthem Blue Cross and Blue Shield’s standard benefits that may vary by plan and product. This does not represent a complete listing of health benefits and level of coverage. It may not include variations such as those based on procedure, patient age, visit number, diagnosis and services that do not apply cost shares.
W Coverage and Benefit Improvements for Members outside the Anthem Blue Cross and Blue Shield East Region – When available from the Home Plan or National Account System, additional information regarding the member is provided within the “Contract Information” and “Member Information” sections of the full Coverage and Benefit Detail page. § Insurance Type Code – Identifies the type of insurance the patient is enrolled in. Valid values include: Health Maintenance Organization and Preferred Provider Organization. § Gender – Indicates whether the patient is female or male. W Claims Payment Reports Available for New Hampshire – Claims Payment Reports are now available for claims submitted on a HCFA/CMS-1500 forms by participating New Hampshire providers and processed locally by Anthem Blue Cross and Blue Shield. These reports are currently available for Connecticut and Maine providers. To access claims status reports, click on the Remittance link, on the Main Menu or in the “new search” box located in the upper right section of the results pages. Please note that this functionality is provided for your convenience and does not constitute a HIPAA transaction. W New Forms and Reference Materials – The following documentation is now available under “Forms and Reference Materials” on the Main Menu. § Connecticut – Updated “Quick Reference Guides – Facility” and Administrative Updates. The following BlueCare Family Plan information is now available: “Policies and Procedures” Manual, “Facts at a Glance” and provider bulletins. § Maine – Updated Working Together. New forms including: participation applications, “Locum Tenes Credentialing Application” and “Prior Authorization Request for CPAP or BiPA”. § New Hampshire – Updated “Provider Communications – Physicians/Providers” and “Provider Communications – Hospitals and Facilities.” P04103
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Coverage and Benefits Search These links contain important information regarding System Updates and available plans
Please note that the instructions explaining the required fields to perform a Coverage and Benefits Search are now in HELP.
Member 1 Search Member 1 is a Maine member enrolled in a locally controlled plan. Therefore, the Member ID and at least the first letter of the First Name are required fields. Date of Birth may be required if more than one match was found on the First Name beginning with “J”. Alternatively the First Name, Last Name and Date of Birth search (located beneath the orange line) is also available. See Search Member 1 Results on page 4.
Member 3 Search Member 3 is enrolled in another Blue Cross and Blue Shield plan. Therefore, the Member ID, First Name, Last Name, Date of Birth and Relationship are required fields. The First Name, Last Name and Date of Birth search is not available for these members.
Member 2 Search Member 2 is a New Hampshire member enrolled in a locally controlled plan. Therefore, the Member ID and at least the first letter of the First Name are required fields. Date of Birth may be required if more than one match was found. Last Name and Date of Birth search is also available. See Search Member 2 Results on page 4.
Tip – see online HELP for information regarding common error messages.
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Coverage and Benefits Multi-Member Results
Please note the detailed instructions about the “More Info…” buttons in HELP.
HCFA/CMS-1500 Remittances are now available for New Hampshire providers. Jane A Doe
XVH0123456789
Barnaby Jones, MD (ID: 010000001NH)
00124
07-04-1976
Member 1 Results: Our system was able to uniquely identify the member without requiring the full First Name or Date of Birth. See detail Results on pages 5-7.
John Q Patient
YGG1234567890 12345
01-01-2002
Click on the [More Info…] button to access additional coverage and benefit detail.
Member 2 Results: Our system was able to uniquely identify the member without requiring Date of Birth. See detail Results on page 5.
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Note Regarding Member 3: At this time, Coverage and Benefits for members enrolled in another Blue Cross and Blue Shield plan are limited and dependent on the information returned by their source system.
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Coverage and Benefits Detail Results
Shortcut links allow you to quickly access specific data without having to scroll down.
Jane A Doe
XVH0123456789
00124
Jane A Doe
07-04-1976
Barnaby Jones, MD (ID: 010000001NH)
Additional coverage and benefit information for this member may be accessible by clicking on the applicable orange button. Note that a gray box indicates that additional information is not available.
Continued…
See detail results on pages 7-8 P04103
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Coverage and Benefits Detail Results Continued
The benefit detail available online represents Anthem Blue Cross and Blue Shield’s most frequently requested standard benefits that may vary by plan and product.
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HELP contains important information regarding the benefits displayed and field definitions. For example, under the “Deductibles” section, you learn the difference between the terms individual and family.
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Coverage and Benefits Detail – More Coverage
Jane A Doe
XVH0123456789
HELP contains important information regarding the benefits displayed and field definitions. For example, under the “Behavioral Health” section you will find diagnosis covered under the parity laws.
Tip – Click on the orange [Close] button, located in the bottom right corner of the screen, to return to the full Coverage and Benefit Detail.
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Coverage and Benefits Detail – Services and Therapies
Santa Claus
XVH1234567890
Active
HELP contains important information regarding the Services and Therapies definitions. For example, under the “Services” section you will learn that Allergy coverage may include specific policies for general treatment, office visits and injections.
Tip – Click on the orange [Close] button, located in the bottom right corner of the screen, to return to the full Coverage and Benefit Detail.
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