Transcript Anthem Healthy Indiana Plan (HIP)

Anthem Healthy Indiana Plan (HIP)
State Sponsored Business
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Plan Overview
*Unlimited
Preventive
Care
• Smoking Cessation
• Prostate Exam
• Mammogram
• Diabetes
• Physical
POWER Account
Covered Services
•Physician Services
•Prescriptions
•Diagnostic Exams
•Disease Management
•Home Health Services
•Outpatient Hospital
•Inpatient Hospital
$1,100 Individual** and State Contributions
•Controlled by Participant to cover initial medical
expenses
INSURANCE COVERAGE
$300,000 Annual Coverage
$1 Million Lifetime Coverage
*Preventive Care is subject to Annual and Lifetime Maximums, not subject to POWER Account.
**Individual POWER Account contribution will not exceed 5% of gross annual income – approximately $200$900 annually.
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Covered Benefits
• Physician Care
– PMPs within 30 miles and specialty
providers within 60 miles of each
member
• Preventative Care Services, such as:
– Mammograms, PAP smears
– Flu shots
– Annual physicals
– Smoking cessation therapies
– Subject to Annual/Lifetime
Maximums
• Specialized Services
-In and outpatient hospital
-Emergency services
-Disease management
-Diagnostic services
-Home health
• Pharmacy
-Minimum of generics covered in
each drug class
-Brand name coverage for drugs
without a generic version
• Mental Health & Substance
Abuse
-Anthem Behavioral Health
• Out of Network Services
-OON services are covered only
when a prior authorization is
obtained.
-Exceptions are Emergency and
Family Planning
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Non-Covered Services
 Samples of HIP non-covered services include:
 Chiropractic Services
 Vision
 Dental (with the exception of an accidental traumatic injury to natural
teeth. In such cases, treatment must be sought within 48 hours of the
injury)
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Custodial Care
Pregnancy Related Services (see next slide)
Out-of-Network Services
 Prior Authorization from Anthem is required (approval
based on network availability)
 Provider must also be an IHCP provider in order to obtain
prior authorization
 Exceptions are Emergency and Family Planning Services
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Pregnancy Related Services
 Pregnant women do not qualify for HIP, as pregnancy services are
covered by the Hoosier Healthwise (HHW) program. If a woman
becomes pregnant while on HIP, her pregnancy will not be covered by
HIP. She will be eligible for HHW and will change programs by
submitting proof of pregnancy and change report form to the State.
 At that time she will be removed from HIP, and all her medical
services, pregnancy-related and other, will be covered under Package
B of Hoosier Healthwise. The State will also pay for any services
incurred for the pregnancy during the time the program switch was
made. She will receive a prorated balance of her POWER Account
upon leaving the program. Following her pregnancy, she may enroll
back in the HIP plan. The plan she chooses will be responsible for
helping her with the transitions to assure a seamless coverage.
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Claims Information
 Anthem Member Identification Card
Alpha Prefix YRK with unique ID# from Anthem ID Card
 Electronic Claims to Anthem
Anthem Payor ID: 00630 -- Professional and 00130 – Institutional
 Claims Filing Address:
PO Box 37010
Louisville, KY 40233-7010
 Follow Anthem Commercial Filing/Billing Requirements
 180 Day Claim Filing Time Limit
Applies to both Professional and Institutional claims
Same as Anthem Commercial
 HIP claims included on Commercial Vouchers/Remittance Advice
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New HIP ID Card
The applicable ER copays are $3.00, $6.00 or $25.00 for parents
based on Federal Poverty Level (FPL).
 <100% FPL - $3.00,
100-150% FPL-$6.00,
151-200% - $25.00
Childless Adult = $25.00 copay
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Important Phone Numbers
Provider Phone Numbers
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Provider Inquiry: 800-345-4344
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Credentialing/Contract Info: 800-455-6805
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Benefits and Eligibility: 800-553-2019
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Prior Authorization/Utilization
Management: 866-398-1922
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Radiology Prior Authorizations: 888-7302817
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Behavioral Health Authorizations:
866-398-1922 Option 3
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Cost Containment (Refunds/Recovery):
800-345-7029
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Prior Authorization Pharmacy: 800-3386180
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Anthem Fraud and Abuse: 877-283-1524
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Pharmacist Services: 800-281-4880
Member Phone
Numbers
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Healthy Indiana Plan Call
Center:
1-877-GET-HIP-9
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Member Benefits and
Eligibility:
800-553-2019
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Member Customer
Service:
800-553-2019
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Member 24-Hour Nurse
Assist Line:
866-800-8780
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Website Information
MyAnthem™ for Provider Tools and Information
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Healthy Indiana Plan Member Eligibility
Radiology Precertification including prefix/procedure list
Claim Payment and Denial Information
Secured Messaging
Medical Policies
Clinical Claims Edits
Provider Maintenance Forms for professional providers
Rapid Updates
Healthy Indiana Plan Provider Operations Manual
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Available on CD by calling our Network Development Department at
800-455-6805
 Claims Filing Information
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