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  • New Anthem UM Vendor in 5 States May be the Beginning of a Wider Shift

    Physical therapists who bill Anthem Blue Cross-BlueShield (BCBS) in California, New York, Indiana, Wisconsin, and Louisiana, get ready for a change: there's a new utilization management (UM) vendor in town.

    APTA has learned that Anthem BCBS is migrating to a new UM vendor, starting with the 5 states listed above. The new UM group is a subsidiary of Anthem known as AIM Specialty Health and replaces previous UM vendor OrthoNet in Medicaid states

    The migration will begin March 1, 2019, for Medicaid patients in New York, Indiana, Wisconsin, and Louisiana. The shift won't happen in California until March 15, 2019, and will include all commercial enrollees. But the migration isn't likely to stop there, according to Elise Latawiec, PT, MPH, APTA lead senior practice management specialist.

    "Anthem also operates in Colorado, Connecticut, Georgia, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio, and Virginia, and manages specialty plans in several other states. From the information received thus far we expect the migration to impact all lines of business in the coming year," Latawiec said, adding that APTA has asked Anthem to notify the association as far in advance as possible so that we may alert membership to the change.

    The new UM system also includes occupational therapy and speech-language-hearing services, and applies to any outpatient place of service, including both on- and off-campus hospital facilities. Anthem BCBS will require that the new UM be applied for patients with all diagnoses for which treatment is delivered in the outpatient setting.

    AIM is holding a series of initial training sessions January 24, January 30, February 24, and February 26, and says it will reach out to invite current Anthem providers to the webinars. Anyone unable to attend a scheduled session will be able to access a recorded version following the 4 trainings.

    APTA will meet with AIM representatives for a follow-up conversation after the initial rollout.

    Want to get a better understanding of the ins and outs of UM? Check out APTA's Utilization Management Toolkit, a members-only online resource with tips, common challenges, and strategies of addressing UM issues.

    Comments

    • Our non-profit, Blue Cross - Blue Shield system should never have been privatized. We had better health care financing in the 1950's! Having said that, I understand that so-called "utilization management" will likely be a part of any health care financing system, but we as a profession should consider strong support for a single-payer, national health care system to replace this profit-driven health insurance Leviathan which is adding cost to healthcare without adding benefit to the public health. It is reprehensible that 64% of patients avoid care due to the expectation of unaffordable health care costs. At the same time, medical care provideers and insurers practice "risk aversion" to avoid patients with high health care costs. Is this "patient-centered" care? I think not.

      Posted by Stephen Small on 1/16/2019 6:44 PM

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