OPA - Project FAIR Update

Magellan recently began moving individual practitioners and providers in group practices from a two-year to a three-year re-credentialing cycle, substantially reducing costs and some of the administrative burdens for both providers and Magellan. The National Committee for Quality Assurance (NCQA) moved to a three-year standard in 2001. In order for Magellan to move to a three-year credentialing cycle, however, we are obtaining approval from customers and applicable regulatory agencies. To date, Magellan has moved providers in all except the following 12 states* to a three-year credentialing cycle:

Moving to the three-year credentialing cycle is expected to save Magellan over $1 million, with the cumulative savings to providers in time and resources expected to exceed this amount.

In support of our ongoing commitment to provide members with access to quality care, Magellan network providers are required to successfully complete the credentialing and contracting processes prior to being accepted as a network provider, then have their credentialing information re-verified and reviewed periodically through the re-credentialing process. We credential providers in accordance with our credentialing criteria and in accordance with specific criteria required by applicable regulatory agencies or client companies.

For more information on Magellan’s credentialing and recredentialing policies, please refer to the Magellan Provider Handbook.

*MDs and DOs in IL must adhere to a state-mandated schedule based upon the last digit of the provider's SSN. TX providers with Tricare (Triwest) contracts must remain on 2-year credentialing cycle per the Tricare contract.

Anthem is transitioning to a new claims payment system for it’s Blue Networks and Blue Products.

As a result of this transition, Anthem is assigning providers a new twelve-digit provider identification number (PIN) to use when filing UB92 and HCFA 1500 claims.

The new 12 twelve-digit PIN can be used immediately on all claims and correspondence for the following networks and products:

Please note that you may also file your BlueCard out of area claims with the new PIN, as well as all National Account member claims. In addition, the new PIN may be used for all Blue Senior, Medicare Supplement and Medicare Select claims with member ID Card prefix YRR. (As a reminder: please note that all claims must be filed with the correct three-digit alpha prefix along with the member ID number.)

You will receive more information about billing with your new PIN in a letter being mailed to you from your local network management representative during 4/1/2003 and 5/31/2003 . Eventually, providers will use one PIN number to bill claims for all products offered in Anthem’s Midwest region.

Providers using electronic data interchange vendors (EDI) or professional billing services to file claims with Anthem should notify these vendors immediately so they can make any necessary format changes to accommodate the new PIN numbers.

Providers in Indiana or Ohio
Until you are notified of your new PIN number, use your existing PIN number for the above mentioned networks/products.

Kentucky facility or ancillary providers
Until you are notified of your new PIN number, use your existing PIN numbers for the above mentioned networks/products.

Kentucky physician/group affiliate or a southern Indiana physician/group affiliate (Orange, Washington, Scott, Jefferson, Clark, Harrison, Crawford or Floyd counties)
These providers have already received a twelve-digit PIN number. Please be sure to use this PIN number as you were instructed. Unless you are making a change to your practice you will not receive another PIN.

For all other networks/products not listed above
Please continue using your old PIN numbers for the Federal Employee Program (FEP), Anthem Benefit Administrators (ABA), and all other products not listed above through 9/30/2003 . Effective 10/1/2003 , the new PIN, must be used on all Anthem claims or they may be returned to you for correction. If you have not previously received this PIN or do not receive notification by 6/30/03 , please contact your local Provider Inquiry or Network.

Electronic claims filing is strongly encouraged to expedite claims processing; however, you may continue to submit paper claims to the following addresses:

Indiana
P.O. Box 37010
Louisville , KY 40233-7010

Kentucky
P.O. Box 37690
Louisville , KY 40233-7690

Ohio
P.O. Box 37180
Louisville , KY 40233-7180

We are providing the 12 digit PIN number(s) indicated below in order to assist you in billing for our new Blue products. This new PIN number should be used on all claims and correspondence for the physician or other health care provider for the following products:

Please note that you may also file your BlueCard out of area claims with the new PIN, as well as all National Account member claims. In addition, the new PIN may be used for all Blue Senior, Medicare Supplement and Medicare Select claims with member ID Card Prefix YRR. (As a reminder: please note that all claims must be filed with the correct three digit alpha prefix along with the member ID number.)

If you are submitting the HCFA 1500 claim form, place the 12 digit PIN number in Field 33 and include your federal tax identification number in Field 25. If you are submitting a UB 92, place the 12 digit PIN number in Field 51 and include your federal tax identification number in Field 5.

PLEASE BEGIN USING THIS PIN IMMEDIATELY. If you are provided with a Group PIN Number in addition to a Physician 12 Digit PIN(s), please utilize the Physician 12 Digit PIN(s) for claims filing purposes. Payment cannot be directed to the physician/health care provider without this PIN.

EXCEPTIONS: Please continue using your old PIN numbers for the Federal Employee Program (FEP), Anthem Benefit Administrators ( ABA ), and any other product not listed above through 9/30/2003 . (Updated communications will be distributed at a later date for these product exceptions.)

*Practice/Group Name:                  (practice/group name shown here)
Group PIN Number:                       (12 digit pin number shown here)
Group Specialty Type:                   (group specialty type shown here)
Tax Identification Number:              (9 digit tax id shown here)
Traditional Plan Effective Date:        (trad effective date shown here)

*Physician(s): **12 Digit PIN Effective Date Specialty Type
(listing of physician name(s) here) (12 digit pin shown here) (effective date here) (specialty shown here)

If you have any questions, please contact an Anthem Blue Cross and Blue Shield representative at the phone number listed below:

Network Management Name: 1-xxx-xxx-xxxx (This section will print specific HSA name and phone number; i.e., Columbus Network Management: 1-614-438-3400.)

We thank you in advance for your cooperation and participation with Anthem as we strive to improve service to our members, physicians and other health care providers.