Anthem Diamond Provider Open Enrollment
What is the Anthem Diamond Provider recognition program?
Program that identifies providers based on quality and cost data from the BCBSA and Anthem BCBS.
What is considered incorrectly using AEG?
Requested AEG for ASO groups that are out of scope
Requested AEG for services denied for no Authorization or referral
•Used adjustment reason “AEG-all other reasons” when the request should have been for “AEG-Incorrect Provider Directory Information.”
•Requesting AEG multiple times for the same member.
What is the CA Commercial Incentive Program?
incentive for members (health plan to member) for successful completion of the test/screenings, they will receive a $25 gift card.
What will the modernization letters include?
UM decision letters
MNoPT
Important Letters
What happens when you submit a adjustment request without a find care screenshot?
It will be returned without processing
What does this program highlight?
Highlights and promotes ADPs, an drives their utilization through displaying ADP recognition in find care provider records, offering personalized match recommendations and designing benefits that provides lower cost shares
What can happen if you incorrectly use AEG?
Can lead to FCR failures, repeat callers, and negative member satisfaction.
Can also result in the claim needing to be recouped once the issue is resolved causing further member abrasion.
List 4 services within this incentive program.
Colorectal Cancer Screening
Breast Cancer Screening
Cervical cancer Screening
Diabetes Eye Exam
Child and Adolescent Well Care Visits
What are 3 benefits offered with the modernization letters?
Convenience
Improved Access
Environmentally Friendly
What is the purpose of the JIRA KM document?
The purpose of this document is to determine ownership for opening Jira tickets related to potential issue findings on claims and adjustments.
Finish the sentence;
If the group has selected benefits that include Anthem Diamond provider cost shares, ...............
What is the name of the KM document for AEG guidelines?
Associate Empowerment Guidelines – AEG – SC
What is the time frame for the screenings?
From January 1st, 2024 to December 31st, 2024
What do you tell the member when they call in stating they didn't receive their letter via mail?
They opted in for digital letters
Why is the JIRA process needed?
This process is needed to ensure impacted areas are aware of potential issues during investigation.