Anthem Medicaid KY Medicaid Coverage Area The Kentucky

Anthem Medicaid

KY Medicaid Coverage Area The Kentucky Cabinet for Health and Family Services (CHFS) awarded Anthem Blue Cross and Blue Shield (Anthem BCBS) the bid to be one of the contracted Managed Care Organizations (MCOs) for the Affordable Care Act (ACA) Medicaid expansion. This includes seven of the eight regions, excluding Region 3. 2

Anthem Medicaid Membership • Current membership count is ~ 37, 000. • This membership is comprised of those newly eligible through the ACA. • Open enrollment is currently underway (5/5/14 – 6/18/14) for the existing Medicaid population to change their MCO selection. Any changes elected during open enrollment will take effect 7/1/14. • There will be another open enrollment in the Fall for the entire Medicaid population to change their MCO selection. Changes elected during this open enrollment will take effect 1/1/15. 3

Anthem Medicaid Provider Network • The Medicaid provider network was built by amending the Anthem commercial network agreements to add the Medicaid product and plan requirements. • We have a very comprehensive, statewide network that includes 16, 862 providers. ü Facility 104 ü Ob. Gyn 492 ü PCP 2424 ü Peds 425 ü Spec 12, 965 4

Anthem Medicaid Provider Enrollment • Participation Requirements: ▪ Active Medicaid ID Number ▪ NPI Number ▪ CAQH Application for Anthem credentialing • If participating with Anthem commercial, the credentialing requirement may already be met. 5

Anthem Medicaid Provider Enrollment • Enrollment Process: ▪ Contact Gary Harrod at gary. harrod@anthem. com to request enrollment information. ▪ Complete Provider Information Form ▪ If Medicaid ID is needed, Anthem will assist with the application process and submission to DMS. ▪ Enrollment Packet will be sent via e-mail. Packet will include a detailed cover letter and contract documents. ▪ Anthem credentialing process typically takes 60 days. 6

Provider Support 7

Anthem Medicaid Provider Website www. anthem. com/kymedicaiddoc • • • Provider Manual News& Announcements Provider Directory / Online Provider Search Formulary Secured Services: Eligibility, Precertification, Claims Outpatient Review Forms available at https: //mediproviders. anthem. com/ky/pages/medical. aspx 8

Anthem Medicaid ID Card 9

Billing Guidance • Filing limit: 180 days from the date of service • Electronic claims submissions: Ø Professional payer ID: 00660 Ø Institutional payer ID: 00160 • Paper claims submissions: Kentucky Claims Anthem Blue Cross and Blue Shield P. O. Box 61010 Virginia Beach, VA 23466 10

Anthem Medicaid Authorization Process • Effective 8/1/14, existing Impact Plus members with active eligibility as of 7/31/14 - submit request for service packet to the Anthem outpatient fax line 1 -866 -877 -5229. Ø Request should include progress note, care plan, contact log, RFS grid, signature sheets & other supporting documentation that member was receiving Impact Plus services as of 7/31/14. • For requests for members entering new services on 8/1/14 forward, follow normal process and submit request to the Anthem outpatient fax line 1 -866 -877 -5229. 11

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Key Considerations Providers must be Anthem participating provider to receive Anthem reimbursement Providers must have Kentucky Medicaid ID number Anthem complying with DMS Guidelines provided in State Plan Amendment (13 -022) Approved Provider Types and associated services each provider type may provide http: //chfs. ky. gov/NR/rdonlyres/49 B 44 BF 3 -31 B 1 -4 C 72 -AC 2 FC 6 F 2299 F 7 C 1 D/0/KY 13022 Approval. Letter 179 and. Plan. Pages 2. pdf Billing guidelines as indicated in SPA 13

Key Considerations When considering service provision – suggest to ask yourself: *Is it legal? *Is it ethical? *Is it within DMS guidelines? *Is it compliant with Anthem processes? *What is in contract, following appropriate billing guidelines, etc 14

Key Considerations Anthem encourages individual providers to comply with all guidelines and regulations of respective Boards of Licensure • Billing guidelines. Example : KY BSW 201 KAR 23: 080. Code of ethical conduct Section 8 • Scope of practice • Applicable notifications to members of licensure levels, etc. Example: KY BSW: . Notice to Client. If an employee is practicing under the supervision of a licensed clinical social worker, the employee shall notify in writing each client during the period of the supervision. The notification shall contain: (1) The name, office address, telephone number, and license number of the supervisor of record; and (2) A statement that the employee is licensed by the board. Anthem encourages providers to be familiar with State Plan Amendment on what services each provider type can provide 15

Key Contact Information Provider Services: 1 -855 -661 -2028 Local Provider Relations: 1 -855 -661 -2027 Member Services: 1 -855 -690 -7784 16

Key Contact Information Jeff Sutherland, LCSW Manager II HCMS Behavioral Health Anthem Blue. Cross and Blue. Shield, Medicaid 13550 Triton Boulevard, Louisville, KY 40223 Office: (502) 619 -6800, Ext. 26730 Mobile: (502) 381 -5109 Jeffrey. Sutherland@anthem. com David Crowley, LPCC HCMS Behavioral Health Case Manager II Foster Care Liaison Anthem, Kentucky Medicaid 13550 Triton Boulevard, Louisville, KY 40223 Office: (502) 619 -6800, Ext. 26743 David. Crowley@anthem. com 17

Key Contact Information Jennifer Ecleberry, Director of Provider Engagement & Contracting Anthem Blue Cross and Blue Shield, Medicaid 13550 Triton Park Blvd. , Louisville, KY 40223 Office (502) 619 -6820 Jennifer. Ecleberry@anthem. com Ken Groves, MBA Manager, Provider Network Management Anthem Blue Cross and Blue Shield, Medicaid 13550 Triton Park Blvd. , Louisville, KY 40223 Office (502) 619 -6800, extension 26757 Kenneth. groves@anthem. com Gary Harrod Provider Enrollment Specialist with concentration on Impact Plus Providers gary. harrod@anthem. com 18

Impact Plus Provider Webinars • Anthem will be offering two webinars this month to provide an overview of the Anthem Medicaid plan and guidance on provider enrollment and contracting. Ø Monday, June 23 – 3 pm – 4 pm EST Ø Monday, June 30 – 10 am – 11 am EST • If interested in attending, please RSVP to Libby Ellington at libby. ellington@anthem. com 19

Thank You! Legal Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, Inc. Independent licensee 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. AKYPEC-0092 -13 A [December 2013]