January 19, 2007
Anthem
LaShon Hodge, provider network manager, and Shelley Evans with Network Education for Central Indiana presented information about Anthem’s operations.
Anthem is prepared to accept the new CMS-1500 on March 1, 2007. Anthem requires claims to be filed within 180 days if the physician is contracted and 365 days if the physician is not contracted.
The company also requires the physician’s Anthem PIN on all electronic submissions. If a physician does not have an Anthem PIN, send all claims on paper. Physicians obtain an Anthem PIN by contracting with Anthem for its commercial line of business.
Anthem will distribute insurance cards to its members, in addition to the Hoosier Health Card issued by Medicaid. The words “Medicaid Managed Care” are printed below the Anthem name and logo. Make sure your staff notes the difference between a commercial product for Anthem and a Medicaid product.
Anthem will mail a notification to physicians when the drug formulary list changes.
Representatives distributed Anthem’s temporary policy to relax prior authorization edits only until March 31. Beginning April 1, 2007, Anthem’s documented prior authorization requirements will become effective. Link to Anthem’s temporary relaxed edits policy on ISMA’s online resource OneSource.
Anthem requires the prefix “YRH” plus the 12-digit Medicaid ID number on claim forms to represent patients’ IDs. Anthem also requires all electronic claim submissions include the physician’s Anthem PIN. Therefore, if a physician is not contracted with Anthem and does not have an Anthem PIN, the claim must be submitted on paper with the physician’s Medicaid ID number in box 24K.
The correct claims address is:
P.O. Box 37010
Louisville KY 40233
If a claim is submitted to Magellan or VSP (vision provider), the YRH prefix also is required.
