May 2020 Anthem Blue Cross Provider News - California Page 1 of 27

California Provider NewsMay 2020 Anthem Blue Cross Provider News - California

Behavioral Health:

Administrative:

Reimbursement Policies:

Medical Policy & Clinical Guidelines:

Medicare:

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Now available Anthem Blue Cross’ new Digital Enrollmentapplication for Behavioral Health

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Information from Anthem for Care Providers about COVID-19 3

Anthem Worker’s Compensation offering telehealth 4

Where to mail Anthem Blue Cross Stop Loss claims 5

Member grievance process and forms must be made availableupon request at provider offices

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Diabetes HbA1c testing is essential - coding the CPT II codescorrectly can improve HEDIS results

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Commercial Risk Adjustment prospective program update:Assessing your patients for risk adjustable conditions

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Anthem Blue Cross provider directory and provider dataupdates

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Easily update provider demographics with the online ProviderMaintenance Form

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Network leasing arrangements 14

Reminder about System Update 15

Updates to AIM Musculoskeletal Program Joint Surgery ClinicalApprorpriateness Guidelines

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Reimbursement policy update: unlisted, unspecified ormiscellaneous codes

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New behavioral health Medicare Advantage individual andgroup retiree solutions provider fax

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Prior authorization requirements 17

May 2020 Anthem Blue Cross Provider News - California Page 2 of 27

Medi-Cal Managed Care:

Cal MediConnect:

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Companyare independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Crossname and symbol are registered marks of the Blue Cross Association. Use of the Anthem Web sites constitutes your agreement with our Terms ofUse.

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Multi-dose packaging 17

Reimbursement policy update: Unlisted, unspecified ormiscellaneous codes

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Health education and cultural & linguistics update 19

Tobacco cessation requirements update 22

Electronic stay healthy assessment tool update 23

Diabetes prevention program 24

Reimbursement policy update: Unlisted, unspecified ormiscellaneous codes

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May 2020 Anthem Blue Cross Provider News - California Page 3 of 27

Now available Anthem Blue Cross’ new Digital Enrollmentapplication for Behavioral HealthPublished: May 1, 2020 - Products & Programs / Behavioral Health

Anthem Blue Cross (Anthem) continues to make it easier and more convenient to requestconsideration for participation as a behavioral health provider. The Digital ProviderEnrollment application has been designed to speed up the enrollment process, allowproviders to submit data at one time, and obtain real-time updates on the status of anapplication.

Access to the new application is available through Availity, Anthem’s secure web-basedprovider portal. New and current Availity users should ensure their user ID has the correctaccess. Please ensure that you have been assigned to Provider Enrollment.

Digital provider enrollment offers many benefits:

Supports enrollment of professional providers, whose organizations do not have acredentialing delegation agreement with Anthem

New individual providers or groups can request a contract

Existing groups can add providers to their existing contract

Providers can check the status of an application in real-time using the enrollmentdashboard

To use the new Digital Enrollment application, please confirm your provider data on CAQH is current and

in a complete or re-attested status, then log into Availity and use the following navigation: Choose your

state > Payer Spaces > Provider Enrollment.

URL: https://providernews.anthem.com/california/article/now-available-anthem-blue-cross-new-digital-enrollment-application-for-behavioral-health

Information from Anthem for Care Providers about COVID-19Published: May 1, 2020 - Administrative

For the most up-to-date information from Anthem Blue Cross (Anthem) about COVID-19,

May 2020 Anthem Blue Cross Provider News - California Page 4 of 27

Provider News Home and check back often. The most recentarticles will be displayed in the Provider Spotlight section.

For a repository of all COVID-19 related articles in one location, please

reference the COVID-19 Information (California) under Articles byPublication.

Article Attachments

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URL: https://providernews.anthem.com/california/article/information-from-anthem-for-care-providers-about-covid-19-24

Anthem Worker’s Compensation offering telehealthPublished: May 1, 2020 - Administrative

Anthem Workers’ Compensation, LLC (Anthem) announced a free emergency Telehealthservice program in coordination Transparent Health Marketplace (THM), our technologypartner for the Anthem Marketplace and with Kura MD, the leading provider of workers’compensation Telehealth services. The Kura MD platform gives workers’ compensationproviders the means to deliver select healthcare services to injured workers through asecure, HIPAA compliant videoconference on a smart phone, tablet or computer. As wehave all been advised to limit our physical contact with others and are practicing socialdistancing, this Telehealth platform for physicians comes at an opportune time when morepatients are seeking care in alternative ways. Telehealth will assist physicians in providingremote medical assessments, answers to medical questions, prescriptions and physicaltherapy sessions, and access to behavioral health services for injured workers. The launch

May 2020 Anthem Blue Cross Provider News - California Page 5 of 27

To help providers, Anthem has negotiated with Kura MD to offer discounted provider accessrates. Now until July 1, 2020, access to the KURA MD platform to render basic telehealthservices will be free for a 60-day period from the time they complete their subscription, andproviders can select optional additional services at a nominal cost. Providers who are contracted and participate in the Anthem Workers’ CompensationNetwork, will be able to use the platform with any patient for any plan, network or Payorwilling to participate improving access to medical care for virtually everyone. To subscribe to this emergency program, enroll at https://anthem-wc.com/telehealth.

URL: https://providernews.anthem.com/california/article/anthem-workers-compensation-offering-telehealth

Where to mail Anthem Blue Cross Stop Loss claimsPublished: May 1, 2020 - Administrative

To ensure timely processing of California (CA) Stop Loss claims, we are seeking yourassistance by clearly identifying CA Stop Loss claims. In addition, please update yourrecords of the new physical address when submitting your stop loss claims. Anthem Blue CrossAttn: Hospital Stop Loss UnitP.O. Box 60007Los Angeles, California 90060-0007 Or Anthem Blue CrossAttn: Hospital Stop Loss Unit21215 Burbank Blvd.Woodland Hills, CA 91367

URL: https://providernews.anthem.com/california/article/where-to-mail-anthem-blue-cross-stop-loss-claims

May 2020 Anthem Blue Cross Provider News - California Page 6 of 27

Member grievance process and forms must be made availableupon request at provider officesPublished: May 1, 2020 - Administrative

The Department of Managed Health Care’s (DMHC) routine medical survey includesevaluation of a Health Plan’s compliance with California Health and Safety Code section1368(a)(2); 28 CCR 1300.68(b)(6) and (7). These regulations require Health Plans toensure that grievance forms, a description of grievance procedures, and assistance inling grievances are readily available at each contracting provider’s office, contractingfacility, or Plan facility. Please review and distribute the Anthem Blue Cross (Anthem) grievance form to all yourparticipating offices. It is important to implement processes to provide grievance forms andassistance to Anthem members promptly upon request.

Your agreement with Anthem requires you to comply with all applicable laws andregulations and to cooperate with Anthem’s administration of its grievance program.

Information can be accessed on the process of submitting member grievances andappeals, grievance forms, denitions and appeal rights, on Anthem’s website atwww.anthem.com/ca/forms. Go to View by Topic and click on the drop down menu andselect Grievance & Appeals, and then select the desired resource link. In addition, grievance forms, grievance procedures, Anthem’s expedited grievance andappeals review process, can be found in Anthem’s Provider Operations’ Manual.

Anthem has posted a required learning course via Availity Portal (login required) toensure provider offices have implemented processes to provide grievance forms andassistance to enrollees. Please make sure to complete this course and the requiredattestation by June 1, 2020:

1. Log in to Availity Portal at com.2. At the top of Availity Portal, click Payer Spaces > Anthem Blue Cross.3. On the payer spaces landing page, click Access Your Custom LearningCenter from the Applications4. Search for the Member Grievance Form and Attestation - Online Courseusing keyword grievance.5. Enroll and complete the course, including the required attestation module.

May 2020 Anthem Blue Cross Provider News - California Page 7 of 27

Refer to this guide for more information.

Not registered for the Availity Portal?Have your organization’s designated administrator register your organization for the AvailityPortal.

1. Visit availity.com to register.

2. Click Register.3. Select your organization type.

4. In the Registration wizard, follow the prompts to complete the registration for yourorganization. Refer to these PDF documents for complete registration instructions.

Getting StartedWhen you log in to Availity Portal for the first time, Availity prompts you to:

Accept privacy and security statements

Accept a confidentiality agreement

Choose three security questions and answers

Create a new password

Verify your email address

For questions regarding the Availity Portal, please contact Availity Client Services at 1-800-282-4548.

We appreciate your cooperation and support.

URL: https://providernews.anthem.com/california/article/member-grievance-process-and-forms-must-be-made-available-upon-request-at-provider-offices-2

Diabetes HbA1c testing is essential - coding the CPT II codescorrectly can improve HEDIS resultsPublished: May 1, 2020 - Administrative

Diabetes is a complex chronic illness requiring ongoing patient monitoring. NCQA includes

May 2020 Anthem Blue Cross Provider News - California Page 8 of 27

Which HEDIS measures are Diabetes Measures?The diabetes measures focus on members 18-75 years of age with diabetes (type 1 andtype 2) who had each of the following assessments:

Hemoglobin A1c (HbA1c) testing

HbA1c poor control (>9.0%)

HbA1c control (<8.0%)

Dilated Retinal exam

Medical attention for nephropathy

The American College of Physicians’ guidelines for people with type 2 diabetes recommendthe desired A1c blood sugar control levels remain between 7 to 8 percent.

In order to meet the HEDIS measure “HbA1c control <8”, you must document the date thetest was performed and the corresponding result. For this reason, report one of the fourCategory II codes and use the date of service as the date of the test, not the date of thereporting of the Category II code.

To report most recent hemoglobin A1c level hemoglobin A1c level greater than or equal to8.0% and less than 9.0%, use 3052F. To report most recent A1c level ≤9.0%, use codes3044F, 3051F, 3052F.

1. Most recent hemoglobin A1c level less than 7.0% use 3044F

2. Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than8.0% use 3051F

3. Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less thanor equal to 9.0% use 3052F

4. Most recent hemoglobin A1c level greater than 9.0% use 3046F

NOTE: Multiple dates of service may be associated with a single lab test (e.g., a collectiondate, a reported date and a claim date). For a laboratory test CPT II code to count towardHEDIS, the Category II date of service and the test result date must be no more than sevendays apart.

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Continued management and diverse pathways to care are essential in controlling bloodglucose and reducing the risk of complications. While it is extremely beneficial for the patientto have continuous management, it also benefits our providers. As HEDIS rates increase,there is potential for the provider to earn maximum or additional revenue through Pay forQuality, Value Based Services, and other pay-for-performance models.

Sources include:− Diabetes Prevalence: 2015 state diagnosed diabetes prevalence, cdc.gov/diabetes/data;2012 state undiagnosed diabetes prevalence, Dall et al., ”The Economic Burden of ElevatedBlood Glucose Levels in 2012”, Diabetes Care, December 2014, vol. 37.− Diabetes Incidence: 2015 state diabetes incidence rates, cdc.gov/diabetes/data− Cost: American Diabetes Association, “Economic Costs of Diabetes in the U.S. in 2017”,Diabetes Care, May 2018.− Research expenditures: 2017 NIDDK funding, projectreporter.nih.gov; 2017 CDC diabetesfunding, www.cdc.gov/fundingprofiles https://www.medicalnewstoday.com/articles/321123#An-A1C-of-7-to-8-percent-is-

recommended https://www.ama-assn.org/system/files/2020-01/cpt-cat2-codes-alpha-listing-clinical-

topics.pdfhttps://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/value-based-

programs/value-based-programs.html

URL: https://providernews.anthem.com/california/article/diabetes-hba1c-testing-is-essential-coding-the-cpt-ii-codes-correctly-can-improve-hedis-results

Commercial Risk Adjustment prospective program update:Assessing your patients for risk adjustable conditionsPublished: May 1, 2020 - Administrative

We understand the increased risk and strain on the health care system during the fightagainst COVID-19, and we support you in the response and treatment of your patients.Telehealth is now an option to assess your patients with risk adjustable conditions.Anthem’sProspective Risk Adjustment program works to improve risk adjustment accuracy and focuson performing appropriate interventions for patients with undocumented HierarchicalCondition Categories (HCC) in order to help you close your patients’ gaps in care. Thisprogram involves:

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Member outreach encouraging primary care physicians (PCP) in-person or telehealthvisits.

Refer to Anthem’s COVID-19 FAQ in Provider News for updates about telehealthreimbursement guidance.

Provider outreach sharing previously coded and suspected conditions, andencouraging member visits

PCP alternatives to complete Health Assessments

Inovalon requestsConsistent with 2019, we have again engaged a vendor, Inovalon – an independentcompany that provides secure, clinical documentation services – to help us comply with theprovisions of the Affordable Care Act that require us to assess members’ relative health risklevels. In the coming weeks and months, Inovalon will begin sending letters to providers aspart of a new risk adjustment cycle, asking for your help with completing HealthAssessments for some of our members.

If you worked with Inovalon in 2019, many thanks for your help. This year will bring a newround of assessments because chronic conditions must be assessed and coded each andevery year. As always, if you have questions about the requests you receive, you can reachInovalon directly at 1-877-448-8125.Prospective Program ask of Providers:

Anthem network providers – usually PCPs – receive letters from Inovalon,requesting that they:

1. Schedule a comprehensive in-person or telehealth visit withpatients identified by Inovalon to confirm or deny if previously coded

May 2020 Anthem Blue Cross Provider News - California Page 11 of 27

or suspected diagnoses exists, and;

1. Submit a Health Assessment documenting the previously codedor suspected diagnoses (also called SOAP Notes - Subjective,Objective, Assessment and Plan).

Incentives for properly submitted Health Assessments (these incentives are inaddition to the office visit reimbursement):

$100 for each Health Assessment properly submitted electronically

$50 for each Health Assessment properly submitted via fax

Submit electronically via Inovalon’s ePASS tool:

Inovalon ePASS Training Webinars

Every Wednesday – 3 to 4 p.m. EST

Join an ePASS webinar:

Register by sending an email to ePASSProviderRelations@inovalon.comwith your name, organization, contact information and the date of thewebinar you wish to attend.

Alternative EngagementePASS® is our preferred method for submission. However to improve engagement andcollaborate with our providers who are not submitting via ePASS®, we have identified othertools which may be helpful. If in 2019 your practice utilized some of these alternative optionsfor prospective member outreach, we thank you for continuing these alternative forms ofprogram participation into 2020.

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For those providers not familiar with our alternative options, they are listed here. Telehealthvisits are also an acceptable form of a patient visit for these alternative engagement options.Any questions your office has about these options can be directed to either your localprovider representative, or the Anthem CRA network education representative listed below.

EPHC Providers using PCMS – Providers participating in our Enhanced PersonalHealth Care (EPHC) program can use member reports from our PCMS tool to schedulemembers for comprehensive visits. PCMS does have a link to take you directly to theInovalon ePASS® tool where completed Health Assessments will result in a $100incentive payment per submitted Health Assessment.

List of Members to be scheduled – Anthem CRA provides member/patient reports forproviders to schedule members for comprehensive visits. Providers use normal gapclosure through claims submission. No Health Assessment needed. Not eligible foradditional incentive.

EPIC Patient Assessment Form (PAF) – Providers with EPIC as their electronicmedical record (EMR) system can fax the EPIC PAF to Inovalon at 1-866-682-6680 with acoversheet indicating "see attached Anthem Progress Note,” which is eligible for a $50incentive payment.

Providers Existing Patient Assessment Form (PAF) – Utilize providers existing EMRsystem and applicable PAF. Must be submitted to Inovalon at 1-866-682-6680 withcoversheet indicating, "see attached Anthem Progress Note,“ which is eligible for a $50incentive payment.

Please contact our Commercial Risk Adjustment Network Education Representative if youhave any questions via email at Socorro.Carrasco@anthem.com. Thank you for your continued efforts with our CRA Program.

May 2020 Anthem Blue Cross Provider News - California Page 13 of 27

URL: https://providernews.anthem.com/california/article/commercial-risk-adjustment-prospective-program-update-assessing-your-patients-for-risk-adjustable-conditions

Anthem Blue Cross provider directory and provider data updatesPublished: May 1, 2020 - Administrative

It is extremely important that we have accurate and up-to-date information about your practice in our

directories. Senate Bill 137 (SB 137) requires that Anthem Blue Cross (Anthem) provide our members

accurate and up-to-date provider directory data. As a result, Anthem will be conducting ongoing

outreaches to all practices to confirm the information we have on file is accurate. Without verification from

you that our Provider Directory information is accurate, we will be required to remove your practice from

the directories we make available to our members. We appreciate your attention to this matter

URL: https://providernews.anthem.com/california/article/anthem-blue-cross-provider-directory-and-provider-data-updates-19

Easily update provider demographics with the online ProviderMaintenance FormPublished: May 1, 2020 - Administrative

Anthem Blue Cross (Anthem) providers should now submit changes to their practice profileusing our online Provider Maintenance Form. Online update options include: add an address location, name change, tax ID changes,provider leaving a group or a single location, phone/fax numbers, closing a practicelocation, etc. Visit the Provider Maintenance Form landing page to review more.

The new online form can be found the redesigned provider site www.anthem.com/ca, selectthe Providers tab then select Provider Maintenance Form in the sub bullets. In addition, theProvider Maintenance Form can be accessed through the Availity Web Portal by selectingCalifornia> Payer Spaces-Anthem Blue Cross> Resources tab >Provider MaintenanceForm.

Important information about updating your practice profile:

May 2020 Anthem Blue Cross Provider News - California Page 14 of 27

Change request should be submitted using the online Provider MaintenanceForm

Submit the change request online. No need to print, complete and mail, fax or emaildemographic updates

You will receive an auto-reply e-mail acknowledging receipt of your request andanother email when your submission has been processed

For change(s) that require submission of an updated IRS Form w-9 or otherdocumentation, attach them to the form prior to submitting

Change request should be submitted with advance notice

Contractual agreement guidelines may supersede effective date of request

You can check your directory listing on the Anthem Blue Cross: “Find a Doctor tool”. The Find a Doctor

tool at Anthem is used by consumers, members, brokers, and providers to identify in-network physicians

and other health care providers supporting member health plans. To ensure Anthem has the most current

and accurate information, please take a moment to access the Find A Doctor tool (www.anthem.com/ca,

select the Providers tab, then select the Find A Doctor in the sub bullets) and review how you and your

practice are being displayed.

URL: https://providernews.anthem.com/california/article/easily-update-provider-demographics-with-the-online-provider-maintenance-form-19

Network leasing arrangementsPublished: May 1, 2020 - Administrative

Anthem Blue Cross (Anthem) has network leasing arrangements with a variety oforganizations, which we call Other Payors. Other payors and affiliates use the Anthemnetwork.

Under the terms of your provider agreement, members of other payors and affiliates aretreated like Anthem members. As such, they’re entitled to the same Anthem billingconsiderations, including discounts and freedom from balance billing. You can obtain theOther Payors list on the Availity web portal, at www.Availity.com. From the Availity site,select Home > Anthem California > Education and Reference Center, or email us atCAContractSupport@Anthem.com.

May 2020 Anthem Blue Cross Provider News - California Page 15 of 27

URL: https://providernews.anthem.com/california/article/network-leasing-arrangements-19

Reminder about System UpdatePublished: May 1, 2020 - Policy Updates / Reimbursement Policies

As a reminder, we are continuing to update our claim editing software for outpatient claimson a monthly basis throughout 2020. These updates will:

reflect the addition of new, and revised codes (e.g. CPT, HCPCS, ICD-10, modifiers)and their associated edits

include updates to National Correct Coding Initiative (NCCI) edits

include updates to incidental, mutually exclusive, and unbundled (rebundle) edits

include assistant surgeon eligibility in accordance with the policy

include edits associated with reimbursement policies including, but not limited to,frequency edits, medically unlikely edits, bundled services and global surgery preoperativeand post-operative periods assigned by The Centers for Medicare & Medicaid Services(CMS)

apply to any provider or provider group (tax identification number) and may apply to both

institutional and professional claim types including looking across claim types to determine where

conflicts may exist between professional (CMS-1500) claims and institutional (CMS-1450) claims.

URL: https://providernews.anthem.com/california/article/reminder-about-system-update

Updates to AIM Musculoskeletal Program Joint Surgery ClinicalApprorpriateness GuidelinesPublished: May 1, 2020 - Policy Updates / Medical Policy & Clinical Guidelines

In February 2020, Anthem Blue Cross notified providers in writing, effective for dates ofservice on and after May 17, 2020, updates will apply to the AIM Musculoskeletal Program:Joint Surgery Clinical Appropriateness Guidelines. These updates relate to the criteria in thefollowing sections:

May 2020 Anthem Blue Cross Provider News - California Page 16 of 27

Hip arthroplasty

Knee arthroscopy and open procedures

Shoulder arthroplasty including the removal of the indication for subacromialimpingement with rotator cuff tear

Access AIM’s ProviderPortal directly at providerportal.com. Online access isavailable 24/7 to process orders in real-time, and is the fastest and most convenient wayto request authorization.

Access AIM via the Availity Web Portal at availity.com

Call the AIM Contact Center toll-free number: 1-877-291-0360, Monday – Friday, 7:00a.m. – 5:00 p.m. PT.

For questions related to guidelines, please contact AIM via email at

aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the

current and upcoming guidelines here.

URL: https://providernews.anthem.com/california/article/updates-to-aim-musculoskeletal-program-joint-surgery-clinical-approrpriateness-guidelines

Reimbursement policy update: unlisted, unspecified ormiscellaneous codesPublished: May 1, 2020 - State & Federal / Medicare

Effective August 1, 2020, Anthem Blue Cross will continue to allow reimbursement forunlisted, unspecified or miscellaneous codes. Unlisted, unspecified or miscellaneous codesshould only be used when an established code does not exist to describe the service,procedure or item rendered. Reimbursement is based on review of the unlisted, unspecifiedor miscellaneous codes on an individual claim basis. Claims submitted with unlisted,unspecified or miscellaneous codes must contain specific information and/or documentationfor consideration during review.

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For additional information, please review the Unlisted, Unspecified or Miscellaneous Codesreimbursement policy here.

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URL: https://providernews.anthem.com/california/article/reimbursement-policy-update-unlisted-unspecified-or-miscellaneous-codes-6

New behavioral health Medicare Advantage individual and groupretiree solutions provider faxPublished: May 1, 2020 - State & Federal / Medicare

You can view more information about the new behavioral health Medicare Advantage individual and

Group Retiree Solutions provider fax.

URL: https://providernews.anthem.com/california/article/new-behavioral-health-medicare-advantage-individual-and-group-retiree-solutions-provider-fax

Prior authorization requirementsPublished: May 1, 2020 - State & Federal / Medicare

Learn more about Prior Authorization Requirements.

URL: https://providernews.anthem.com/california/article/prior-authorization-requirements

Multi-dose packagingPublished: May 1, 2020 - State & Federal / Medicare

Anthem Blue Cross wants to make multi-dose packaging available to your patients to helpsupport medication adherence. It’s a simpler, safer way for your patients to manage theirmedications. Multi-dose packaging is a free service available to members at select networkpharmacies.

May 2020 Anthem Blue Cross Provider News - California Page 18 of 27

What is multi-dose packaging?Multi-dose packaging (MDP) involves organizing prescription and over-the-counter productsto provide ease to patients when taking their routine medications. Each MDP dispenserprovides patients with a personalized roll of pre-sorted medication packs, labeled with thedate and time of the patient's next scheduled dose. MDP helps reduce the stress ofdetermining which medications to take, when to take them and how much of them to take.

Who provides these services?MDPs can be shipped to the CVS* retail pharmacy of choice or directly to a patient’s homeat no additional charge. The MDP Care team is available 24/7 to address patient questionsand concerns. The team also coordinates mid-month prescription changes with local CVSpharmacies. CVS MDP is licensed in all states and the District of Columbia. If CVS is not the right fit based on geography, PillPack* can provide MDP services for yourpatients. Packages can include prescription medication, over-the-counter medication andvitamins, and will include a date and time stamp on each packet to help your patientsremember to take their medications. Patient copays should be the same; in some cases, itmay be cheaper. How do I refer my patients to MDP providers?For CVS: Patients can enroll online at https://www.CVS.com/multidose or call 1-800-753-0596. Patients residing in the District of Columbia, Georgia or South Carolina should call 1-844-650-1637 (due to remote practice restrictions). Members may also enroll at their localCVS pharmacy. For PillPack: Patients interested in PillPack can enroll online athttps://www.pillpack.com/blue or via phone by calling 1-866-282-9462.

* CVS is an independent company providing pharmacy services on behalf of Anthem BlueCross. PillPack is an independent company providing pharmacy services on behalf ofAnthem Blue Cross.

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URL: https://providernews.anthem.com/california/article/multi-dose-packaging-6

May 2020 Anthem Blue Cross Provider News - California Page 19 of 27

Reimbursement policy update: Unlisted, unspecified ormiscellaneous codesPublished: May 1, 2020 - State & Federal / Medi-Cal Managed Care

Effective August 1, 2020, Anthem Blue Cross will continue to allow reimbursement forunlisted, unspecified or miscellaneous codes. Unlisted, unspecified or miscellaneous codesshould only be used when an established code does not exist to describe the service,procedure or item rendered. Reimbursement is based on review of the unlisted, unspecifiedor miscellaneous codes on an individual claim basis. Claims submitted with unlisted,unspecified or miscellaneous codes must contain specific information and/or documentationfor consideration during review. For additional information, please review the Unlisted, Unspecified or Miscellaneous Codesreimbursement policy here.

URL: https://providernews.anthem.com/california/article/reimbursement-policy-update-unlisted-unspecified-or-miscellaneous-codes-7

Health education and cultural & linguistics updatePublished: May 1, 2020 - State & Federal / Medi-Cal Managed Care

Health education classes are available at no charge to Anthem Blue Cross (Anthem)members enrolled in Medi‑Cal Managed Care (Medi-Cal) and are accessible upon self-referral or referral by Anthem network providers. Typically, these classes take place with ourhospital and community organization partners; however, one-on-one counseling with acertified health educator is also available. Class availability varies by county. Topics include the following:

Asthma management

Childbirth/Lamaze/prenatal education

Diabetes management

Injury prevention

Nutrition, obesity and weight management

Parenting/well child

Smoking cessation/tobacco prevention

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Substance use

To refer a member to a health education class, just fill out the Health Education Referralform located on the provider website:https://mediproviders.anthem.com/ca/pages/health-education-programs.aspx. Health education materialsAnthem has an extensive selection of health education materials in both English andSpanish for providers and members. Providers can access health education informationthrough the provider website by selecting the Health Education Programs option in theProvider Support webpage or by following this link:https://mss.anthem.com/ca/pages/health-wellness.aspx. Providers can also requestadditional health education materials through their Network Relations or QualityManagement representatives:

Southern regional office: 1-818-291-6914Central regional office: 1-559-353-3500Northern regional office: 1-888-252-6331

Health education materials may be translated into additional languages upon request. Theyare also available in alternative formats, including Braille, large print and audio. Contact theCustomer Service number on the back of the member card to request these formats.Translations and alternative formats are free of charge.

Free language assistance programsOur members count on our providers for medical care and treatment; however, they mayexperience language barriers, which make it difficult to ask questions or communicate theirconcerns. Anthem is committed to reducing the impact of language barriers for our Medi-Calpatients to obtain language assistance. Providers must notify members of the availability ofinterpreter services and strongly discourage the use of friends and family, particularlyminors, to act as interpreters. Under the federal guidance, published as section 1557 of theAffordable Care Act, providers are required to use qualified interpreters while interacting withmembers with limited English proficiency. To obtain free interpreting services, please call one of our Medi-Cal Customer Care Centers:

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Inside L.A. County: 1-888-285-7801 (TTY 711)Outside L.A. County: 1-800-407-4627 (TTY 1-800-735-2922)

It is important that you or your office staff document the member’s language, any refusal ofinterpreter services, and requests to use a family member or friend as an interpreter in themember’s medical record. Request/Refusal of Interpreter Services forms are available inthreshold languages on the Free Interpreting Services page of our website, located at:https://mediproviders.anthem.com/ca/pages/free-interpreting-services.aspx. During regular business hours, providers and members may contact the Medi-Cal CustomerCare Center using the number located on the back of the member’s ID card. After hours, the24/7 NurseLine is available at 1‑800‑224‑0336. When requesting interpreter assistance:

Give the Customer Care associate the member’s ID number.

Explain the need for an interpreter and the language required.

Wait on the line while the connection is made.

Once connected, the interpreter, an Anthem associate or nurse introduces the Medi-Cal member, explains the reason for the call and begins the dialogue.

Providers and members may contact the Medi-Cal Customer Care Center to schedule face-to-face interpreter services for medical appointments during regular business hours. Threebusiness days in advanced notice is required to schedule face-to-face interpreter services. A24-hour cancellation is required. Providers may also schedule face-to-face interpreterservices by sending an email to ssp.interpret@anthem.com and typing secure in the subjectline. This is a secure email requiring registration. Members with hearing or speech impairments may use the Medi-Cal Customer Care CenterTTY number during regular business hours. After hours, the 24/7 NurseLine TTY numbermay be used. Members can also use the state relay service line by dialing 711. CustomerCare Center associates can also assist non-TTY users who need to contact members whoonly use TTY equipment, (for example, providers needing to contact members with TTYassistive devices). Members may request health plan materials in alternative formats such as Braille, large print, audio CD,

verbal interpretations and non-English languages at no cost by contacting the Medi-Cal Customer Care

Center number located on the back of their ID cards.

May 2020 Anthem Blue Cross Provider News - California Page 22 of 27

URL: https://providernews.anthem.com/california/article/health-education-and-cultural-linguistics-update

Tobacco cessation requirements updatePublished: May 1, 2020 - State & Federal / Medi-Cal Managed Care

PCPs and their qualified staff are required to implement tobacco cessation interventions asoutlined in the California Department of Health Care Services All Plan Letter 16-014 datedNovember 30, 2016. These interventions include:

Conducting initial and annual assessments of all members, of any age, who usetobacco products or are exposed to tobacco smoke, and documenting this information inthe member’s medical record. Per the United States Preventive Services Task Forcerecommendations, this can be accomplished by instituting a tobacco user identificationsystem by:

Using the Staying Healthy Assessment or other individual health education behaviorassessments.

Adding tobacco use as a vital sign in the chart or electronic health record, or by useof the ICD‑10-CM codes in the medical record-to-record tobacco use. Refer to theCoding Guide for Tobacco Use for codes that can be used.

Placing a stamp or sticker on the chart when the member indicates he or she usestobacco.

Prescribing FDA-approved tobacco cessation medications to nonpregnant adults ofany age. Adults who use tobacco products and are enrolled in Medi-Cal Managed Care(Medi-Cal) are covered for all FDA-approved tobacco cessation medications. Thisincludes over-the-counter medications with a prescription from the provider.

Referring tobacco users of any age to available individual, group and telephonecounseling. Anthem Blue Cross (Anthem) members qualify for four counseling sessions,each for a minimum of 10 minutes, for at least two separate quit attempts each yearwithout prior authorization. Providers can:

Use the 5A’s model or other validated behavior change model when counselingmembers.

May 2020 Anthem Blue Cross Provider News - California Page 23 of 27

Refer a member to the CA Smokers Helpline at 1-800-NO-BUTTS (1-800-662-8887)or another equivalent line. The CA Smokers Helpline is available in various languages.

Refer to available community programs. For help locating community programs, usethe health education referral form located on the provider website athttps://mediproviders.anthem.com/ca > Provider Support > Health EducationPrograms > Health education & cultural and linguistic referral form.

Asking all pregnant women if they use tobacco or are exposed to tobacco smoke. Ifthey smoke, offer at least one face-to-face counseling session per quit attempt and referto a tobacco cessation quit line. Counseling services will be covered for 60 days afterdelivery. Smoking cessation medications are not recommended during pregnancy.

Providing education, including brief counseling, to school-age children and adolescentsto prevent initiation of tobacco.

Anthem will monitor provider performance in implementing these tobacco cessationinterventions through various processes comprised of medical record review, facility sitereview, and review of medical or pharmacy claims data. If your office would like tobacco cessation education materials or more information about therevised policy letter, please call the appropriate regional health plan office:

Northern region: 1-888-252-6331Central region: 1-559-353-3500Southern region: 1-818-291-6914

URL: https://providernews.anthem.com/california/article/tobacco-cessation-requirements-update

Electronic stay healthy assessment tool updatePublished: May 1, 2020 - State & Federal / Medi-Cal Managed Care

The Department of Health Care Services (DHCS) requires managed care health plans andtheir contracted providers to implement the age-appropriate Staying Healthy Assessment(SHA) questionnaires.

May 2020 Anthem Blue Cross Provider News - California Page 24 of 27

With many offices now using electronic medical records (EMRs), providers can:

Scan the SHA to use it as an EMR.

Add the exact SHA questions into an EMR.

Use the SHA in a different electronic or assessment tool format.

Use another assessment tool such as Bright Futures.

Anthem Blue Cross staff will:

Work with your office either in person or through email correspondence to reviewprinted screenshots of the electronic SHA to ensure all information from thequestionnaires is incorporated word-for-word.

Confirm that any other assessment tools that offices wish to use include the informationthat’s on the SHA.

Submit the appropriate notification form to DHCS at least one month prior to officeimplementation as required along with the printed screenshots.

DHCS requires that providers first notify the health plans by the use of either the SHAElectronic or Other Format Notification Form or Use of Bright Futures Notification Form.These forms can be obtained by calling your local regional health plan at the appropriatephone number below:

Northern region: 1-888-252-6331Central region: 1-559-353-3500Southern region: 1-818-291-6914

URL: https://providernews.anthem.com/california/article/electronic-stay-healthy-assessment-tool-update

Diabetes prevention programPublished: May 1, 2020 - State & Federal / Medi-Cal Managed Care

Medi-Cal Managed Care (Medi-Cal) members at risk for type 2 diabetes will now have

May 2020 Anthem Blue Cross Provider News - California Page 25 of 27

Services are delivered by trained lifestyle coaches and organizations recognized by theCDC. The DPP is a year-long program that consists of weekly sessions with a lifestyle coach forthe first six months and monthly maintenance sessions for the latter six months. Sessionscan be held in a group classroom setting or online. Participants will learn realistic lifestylechanges, emphasizing weight loss through exercise, healthy eating and behaviormodification. Members can determine their eligibility for DPP and enroll through our programadministrator, Solera Health,* by visiting www.solera4me.com/AnthemBC_MediCal to takethe online assessment or by calling 1‑844‑612‑2949 (TTY 711), Monday through Friday from6 a.m. to 6 p.m. PT. Criteria for eligibility include:

At least 18 years of age.

BMI of 25 or greater.

If member is of Asian descent, a BMI of 23 or greater is required.

Blood screening (optional, if available):

Hemoglobin A1C: 5.7% to 6.4%

Fasting plasma glucose: 100 to 125 mg/dL

Oral Glucose Tolerance Test: 140 to 199 mg/dL

Exclusions include no previous diagnosis of end-stage renal disease or type 1 or type 2diabetes; not pregnant (previous gestational diabetes is not an exclusion).

How to become a DPP provider with the Department of Health Care Services (DHCS):Enrolled Medi-Cal providers should have one of the following provider types and will need tosubmit the Medi‑Cal Supplemental Changes Form (DHCS 6209) to DHCS for approval:

Home health agency

Physician group

Physician

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May 2020 Anthem Blue Cross Provider News - California Page 26 of 27

Indian Health services

Rural health clinic

Community hospital (outpatient)

County hospital (outpatient)

DPP suppliers

Once the eligible Medi-Cal provider is approved to become a DPP provider, the provider willreceive a newly established category of service (COS) containing the DPP billing codes, asoutlined in the request for outsourcing. Only enrolled and eligible Medi-Cal providers whohave the DPP COS may bill for DPP services. To get started, refer qualified patients today to www.solera4me.com/AnthemBC_MediCal! References:1 https://www.cdc.gov/diabetes/prevention/prediabetes-type2/preventing.html.2 https://www.dhcs.ca.gov/services/medi-cal/Documents/DPP_OIL_Enclosure_A_Webpage.pdf.

URL: https://providernews.anthem.com/california/article/diabetes-prevention-program-1

Reimbursement policy update: Unlisted, unspecified ormiscellaneous codesPublished: May 1, 2020 - State & Federal / Cal MediConnect

Effective August 1, 2020, Anthem Blue Cross will continue to allow reimbursement forunlisted, unspecified or miscellaneous codes. Unlisted, unspecified or miscellaneous codesshould only be used when an established code does not exist to describe the service,procedure or item rendered. Reimbursement is based on review of the unlisted, unspecifiedor miscellaneous codes on an individual claim basis. Claims submitted with unlisted,unspecified or miscellaneous codes must contain specific information and/or documentationfor consideration during review. For additional information, please review the Unlisted, Unspecified or Miscellaneous Codesreimbursement policy here. 507050MUPENMUB

2

May 2020 Anthem Blue Cross Provider News - California Page 27 of 27

URL: https://providernews.anthem.com/california/article/reimbursement-policy-update-unlisted-unspecified-or-miscellaneous-codes-8