Anthem Healthy Indiana Plan (HIP)

1
Anthem Healthy Indiana Plan (HIP)

• State Sponsored Business

2
Plan Overview

•            

• Covered Services
• Physician Services
• Prescriptions
• Diagnostic Exams
• Disease Management
• Home Health Services
• Outpatient Hospital
• Inpatient Hospital

Unlimited Preventive Care

• Smoking Cessation

• Prostate Exam

• Diabetes

• Mammogram

• Physical

• POWER Account
• 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.
3
Covered Benefits

• Physician Care
• PMPs within 30 miles and specialty providers
  within 60 miles of each member

• Pharmacy
• -Minimum of generics covered in each
  drug class
• -Brand name coverage for drugs without a generic
  version

• Preventative Care Services, such as
• Mammograms, PAP smears
• Flu shots
• Annual physicals
• Smoking cessation therapies
• Subject to Annual/Lifetime Maximums

• 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

• Specialized Services
• -In and outpatient hospital
• -Emergency services
• -Disease management
• -Diagnostic services
• -Home health

4
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)
• 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

5
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.

6
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

7
New HIP ID Card

• The applicable ER copays are 3.00, 6.00 or
  25.00 for parents based on Federal Poverty Level
  (FPL).

• lt100 FPL - 3.00,
• 100-150 FPL-6.00,
• 151-200 - 25.00
• Childless Adult 25.00 copay

8
Important Phone Numbers

• Provider Phone Numbers
• Provider Inquiry 800-345-4344
• Credentialing/Contract Info 800-455-6805
• Benefits and Eligibility 800-553-2019
• Prior Authorization/Utilization Management
  866-398-1922
• Radiology Prior Authorizations 888-730-2817
• Behavioral Health Authorizations
  866-398-1922 Option 3
• Cost Containment (Refunds/Recovery)
  800-345-7029
• Prior Authorization Pharmacy 800-338-6180
• Anthem Fraud and Abuse 877-283-1524
• Pharmacist Services 800-281-4880

• Member Phone Numbers
• Healthy Indiana Plan Call Center
• 1-877-GET-HIP-9
• Member Benefits and Eligibility
• 800-553-2019
• Member Customer Service
• 800-553-2019
• Member 24-Hour Nurse Assist Line
• 866-800-8780

9
Website Information

• MyAnthem for Provider Tools and Information
• 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
• Available on CD by calling our Network
  Development Department at 800-455-6805
• Claims Filing Information