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Anthem Healthy Indiana Plan (HIP)

State Sponsored Business

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Plan Overview

           

*Unlimited Preventive

Care

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

• Smoking Cessation

• Prostate Exam• Mammogram • Physical

• Diabetes

Covered Services•Physician Services

•Prescriptions•Diagnostic Exams

•Disease Management•Home Health Services

•Outpatient Hospital•Inpatient Hospital

*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

• Mental Health & Substance Abuse-Anthem Behavioral Health

• Pharmacy -Minimum of generics covered in each drug class

-Brand name coverage for drugs without a generic version

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

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 AnthemAnthem Payor ID: 00630 -- Professional and 00130 – Institutional

Claims Filing Address:PO Box 37010Louisville, KY 40233-7010

Follow Anthem Commercial Filing/Billing Requirements

180 Day Claim Filing Time LimitApplies to both Professional and Institutional claimsSame as Anthem Commercial

HIP claims included on Commercial Vouchers/Remittance Advice

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New HIP ID Card

<100% FPL - $3.00, 100-150% FPL-$6.00, 151-200% - $25.00 Childless Adult = $25.00 copay

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

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Important Phone NumbersProvider 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

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Website InformationMyAnthem™ 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