The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross and Blue Shield Association. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Virginia: Anthem Health Plans of Virginia, Inc. and underwritten by Matthew Thornton Health Plan, Inc.
HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO products underwritten by HMO Colorado, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc.
RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Indiana: Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Connecticut: Anthem Health Plans, Inc. September 2019 Anthem Provider News - OhioĪnthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. If you have any RADV audit questions/concerns, please contact you have any questions regarding our reporting process, please contact our CRA Network Education Representative In:
The following list of items are not included in the definition of “Psychotherapy notes” and therefore, can be included pursuant to HIPAA: However, any data excluded from the definition of psychotherapy notes must be provided where applicable and pursuant to this request.
ANTHEM DEFINITION PROFESSIONAL
Under HIPAA, psychotherapy notes are defined as “notes recorded (in any medium) by a mental health professional documenting or analyzing the contents of conversation during a private counseling session or a group, joint, or family counseling session and that are separate from the rest of the individual’s medical record. We appreciate your assistance and patience during this process.īe advised that Anthem is not requesting copies of “psychotherapy notes” as defined by the Health Insurance Portability and Accountability Act (HIPAA). Representatives from Anthem or our vendors may reach out to you to request the required medical records and signature attestations. In the event your patients are selected for this RADV audit, please note that Anthem is working with several vendors to collect the needed medical records and signature attestations (if applicable). This audit is to verify that diagnosis codes, which have been submitted on claims and reported to CMS, are accurate, properly documented, and coded with accurate levels of specificity. Providers whose patients during the benefit year 2018 were selected for this audit will receive requests and must provide copies of medical record(s)/chart(s). This audit is in accordance with the provisions of the Patient Protection and Affordable Care Act (PPACA) and its risk adjustment data validation standards.įor this audit, CMS will select a statistically valid sample of Anthem’s members enrolled in an Affordable Care Act (ACA) compliant plan. The Centers for Medicare & Medicaid Services (CMS) is conducting a Risk Adjustment Data Validation (RADV) Audit beginning June 2019 through January 2020. Continuing our 2019 reporting Commercial Risk Adjustment (CRA) updates, Anthem Blue Cross and Blue Shield (Anthem) requests your assistance with respect to our reporting processes.
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