The ISMA gets update on filing St. Francis Hoosier Healthwise claims
The ISMA initiated a conference call Jan. 26 to detail how your Central Indiana practice can determine if patients are in the St. Francis network and be assured of timely payment of those claims. Since Jan. 1, St. Francis Anthem members are only identified as Anthem members on web interchange, and practices have advised the ISMA they cannot differentiate between a St. Francis Anthem member and all other Anthem members.
A system fix for this issue will not be complete until March 31. Therefore, an interim solution is needed.
In the conference call, Anthem representatives first assured the ISMA they would process St. Francis primary medical provider (PMP) claims even if the claims were sent in error to Anthem. Also, the 90-day filing limit will not apply in these cases, and practices should contact Anthem provider services if claims are returned for this reason.
As an interim solution to identify St. Francis Anthem members, please take the following recommended steps:
- Verify patient eligibility
- If patient is an Anthem insured, check the St. Francis PMP listing (link provided at bottom):
- If doctor is not a St. Francis PMP, submit the claim to Anthem.
- If doctor is a St. Francis PMP, submit the claim to St. Francis (except for behavioral health claims and those for family planning, which go to Anthem).
Again, if a St. Francis claim goes in error to Anthem, it will be processed according to the St. Francis guidelines. Also, remember that all claims going to Anthem must have “YRH” prefix before the Recipient Identification (RID) number; the prefix is not necessary for St. Francis claims, only the RID number.
Special services exceptions
On web interchange, VSP is named as the vision vendor for Anthem members; however, St. Francis Anthem members are not required to use VSP. Those members can use any active Indiana Health Coverage Program (IHCP) provider; no authorization is needed.
Also, Anthem is responsible for family planning and behavioral health claims. Submit all those claims to Anthem and NOT to St. Francis Health Network.
More about St. Francis Anthem
St. Francis Health Network handles prior authorization for St. Francis Anthem members. The state-approved prior authorization form includes the St. Francis Health Network prior authorization phone and fax numbers.
St. Francis Health Network pays claims and responds to questions about those claims – from both members and providers.
To assist you, find the listing of St. Francis PMPs on the ISMA website.
Also, read a pertinent St. Francis Health Network communication about the issue.