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Anthem Blue CrossTelehealth Program

Provider Manual

CHHRC1Typewritten TextSeptember 2014 - version 2.4

CHHRC1Typewritten Text

Anthem Blue Cross Revision Date: September 2014 Version 2.4 Telehealth Program Page 2

This page was left intentionally blank.

Table of Contents Provider Manual

Anthem Blue Cross Revision Date: September 2014 Version 2.4 Telehealth Program Page 3

Chapter 1: Introduction to Telehealth ....................................................................... 7

Overview ........................................................................................................................................... 7

Telehealth Program Objectives ........................................................................................................ 8

Telehealth Consultations .................................................................................................................. 8

Open Access Network Model............................................................................................................ 9

Readiness Disclosure Statement .................................................................................................... 10

Misrouted Protected Health Information ...................................................................................... 10

Chapter 2: Telehealth Contacts ................................................................................ 11

Telehealth Department Contacts .................................................................................................... 11

Technical Support for Systems and Software ................................................................................. 11

Provider/Member Services ............................................................................................................ 12

Utilization Management Services ...................................................................................................13

Vision Service Plan ..........................................................................................................................13

Chapter 3: Frequently Asked Questions ...................................................................14

What is Telehealth? ........................................................................................................................ 14

Why Use Telehealth? ...................................................................................................................... 14

What is Anthem Blue Cross Telehealth Program? ......................................................................... 15

What Types of Specialists Are Available? ....................................................................................... 15

How Does It Work? ......................................................................................................................... 15

For Live Video Telehealth: ........................................................................................................... 15

For Store and Forward Telehealth: ............................................................................................. 16

What Documentation is Required? ................................................................................................ 16

Whom Do I Call with Questions? ................................................................................................... 16

Chapter 4: Site Locations ......................................................................................... 17

StepByStep Instructions ............................................................................................................... 17

Chapter 5: Roles and Responsibilities ......................................................................19

Anthem Blue Cross ......................................................................................................................... 19

Presentation Sites ........................................................................................................................... 19

Table of Contents Provider Manual

Anthem Blue Cross Revision Date: September 2014 Version 2.4 Telehealth Program Page 4

Specialty Centers ............................................................................................................................ 20

Chapter 6: When to Choose Telehealth .................................................................... 21

Assessing Telehealth Services ........................................................................................................ 21

Evaluating Telehealth Opportunities.......................................................................................... 21

Assessment for Appropriate Type of Telehealth Consultation .................................................. 23

Chapter 7: How to ................................................................................................ 24

Refer a Patient for Telehealth Services .......................................................................................... 24

Assess the Patients Appropriateness for Telehealth Services ................................................... 24

Request Patients Verbal Consent for a Telehealth Consult ....................................................... 24

Request a Consultation ............................................................................................................... 25

Determine Appropriate Consultant Type ................................................................................... 25

Prepare and Schedule a Telehealth Encounter .............................................................................. 26

After Sending the Store and Forward Consultation Request ..................................................... 26

Schedule the Telehealth Consultation ........................................................................................ 27

Finalize Details One Day Prior to the Scheduled Appointment ............................................... 27

Finalize Details Immediately Before the Scheduled Appointment .......................................... 28

Conduct a Telehealth Consultation ................................................................................................ 28

During the Patients Appointment .............................................................................................. 28

Post Consultation ........................................................................................................................... 30

Evaluate and Implement the Recommended Treatment Plan from the Telehealth Specialist .... 30

Chapter 8: Claims and Billing ................................................................................. 32

Overview ......................................................................................................................................... 32

Electronic Professional Billing ....................................................................................................... 33

Anthem Blue Cross Utilization Controls and Procedures ............................................................. 33

Telehealth Billing for California Programs .................................................................................... 34

Fee Schedule ................................................................................................................................ 34

Modifiers ..................................................................................................................................... 34

Billable Codes for Telehealth ...................................................................................................... 35

Table of Contents Provider Manual

Anthem Blue Cross Revision Date: September 2014 Version 2.4 Telehealth Program Page 5

Telecommunication Charges ...................................................................................................... 35

Billable CPT Codes for Live Video Telehealth Encounters ........................................................ 36

Site Fees for Live Video ............................................................................................................... 36

Billable Codes for Store and Forward Telehealth Encounters ...................................................... 37

Telecommunication Charges ...................................................................................................... 37

Specialists .................................................................................................................................... 37

Site Fees for Store and Forward ................................................................................................. 37

Submitting Telehealth Claims .................................................................................................... 38

Chapter 9: Developing Telehealth Medical Record Documentation ......................... 47

Introduction.................................................................................................................................... 47

Monitoring Usage and Reporting to Anthem Blue Cross .....................................................

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