Are you a provider that provides services for MLTC members that have the MLTC Plan type through Anthem BCBS- then this blog post is for you!
The following changes take affect for any DOS after 3/1/25:
-MLTC member ID numbers
-Electronic funds transfer (EFT): EnrollSafe replaced Payspan as the EFT website.
-Availity Essentials replaced Payspan for provider remittances (ERA).
Authorizations for personal care services, social daycare, and meals will be issued in weekly units and will no longer contain a fixed daily schedule, allowing for greater flexibility in service provision and billing.
Claims-related updates:
-Access claim status information in Availity Essentials.
–Paper claims submission address
-Aligned claim timely filing guidelines.
-Value code and rate code are required for nursing home claims.
-Bill types and revenue codes were aligned for specific service.
-Check run days were changed to Wednesdays and Saturday
What is not affected:
-Authorization information is available on the legacy MLTC Provider Portal.
-Electronic claim submission — Payer ID 45302 for MLTC claims
-EDI claims submissions using Availity Essentials
-Claim dispute process
-Clinical appeal process
-The Care Management, Provider Services, and Provider Relations teams
For more information regarding these changes please visit: Anthem Provider Manual- MLTC
https://providers.anthem.com/new-york-provider/resources/manuals-policies-guidelines
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