1. health and fitness
2. addiction
3. smoking addiction

Vol. 1 2007
In this issue of STAT, the Anthem Blue Cross Blue Shield Partnership Plan,
Inc. (Anthem Partnership Plan) State Sponsored Business Provider e-News,
you will find important policy updates and new programs or services to
help you take care of our members in the Healthy Start & Healthy Families
(HS&HF) program and the Aged, Blind, or Disabled (ABD) program.
Features
Vaccine News
The CDC updated vaccine recommendations
for children from ages 11 to 18. Learn
more about the new guidelines. We
encourage providers to comply with these
recommendations. Full story
Table of Contents
To view a specific article, click the
article title, and it will take you directly to
the story.
Policy and Benefits
5 Professional Provider Fee
Schedule Available
5 Newborn Billing
6 Prior Authorization and Eligibility Verification Waiver Period Ends
6 Prior Authorization Toolkit
6 Looking for Answers? Check Your
Ohio Provider Operations Manual
Value-Added
Benefits
7 2007 Guidelines
Members have extra benefits and
services available to them such as
no copayments for office visits and
prescriptions, added adult vision
benefits, incentives for completing
postpartum visits and more.
Full story
• Clinical Practice Guidelines
• Preventive Health Care Guidelines
• Clinical Utilization
Management Guidelines
Operations
8 How Quality Improvement Works
8 Medical Record Review Process
10 How Utilization Management
Makes Decisions
How to Help Smokers
The Last Cigarette (TLC) program is a free
resource we provide to help smokers quit. We need
your help reaching members who smoke. Members
can request our free TLC Quit Kit and attend a
smoking cessation class. And members who request
a quit kit or attend a class earn points toward valueadded rewards in our Healthy Returns 4 Healthy
choices program. You can also prescribe Nicotine
Replacement Therapy. Full story
Health Improvement
11 Perform Initial Health Assessments
Rx Updates
12 Prior Authorization of Benefits (PAB)
12 Generic Medications
Physician & Provider e-News, Vol. 1 2007
Features
Vaccine News
What You Need to Know
The Society for Adolescent Medicine and the Centers for
Disease Control and Prevention (CDC) now recommend
the following three vaccine updates for children 11 to 18
years of age:
primary care. As a provider, you have the greatest influence
over whether our members receive vaccinations that help
protect their health. We strongly encourage provider
compliance with these vaccination recommendations.
• Meningococcal (MCV4):
Administer one shot at 11 to 12 years of age, or, when
entering high school or college.
Billing Information
If you are a provider who administers vaccines to children
under the age of 19, you must be enrolled in the Vaccines for
Children (VFC) Program. To enroll, call 1-614-466-4643.
• Tetanus-diptheria-acellular pertussis (Tdap):
Administer one shot from 11 to 18 years of age.
In Ohio, claims covered by the VFC program should be
billed as follows:
• Human Papilloma Virus (HPV):
Administer three doses to females at 11 to 12 years of age.
(May be given as early as age 9 and up to 26 years of age.)
• The administration fee procedure code should not
be billed. The “SL” modifier is not needed for
administration or immunization codes. The appropriate
immunization code should be used for each vaccine, as
indicated below.
According to CDC data for 2001 to 2002, more than 85
percent of all U.S. children ages 6 to 17 years have visited
their primary care provider or clinic within the past 12
months, and 92 percent of adolescents have a source for
Immunizations Covered Under the VFC Program in Ohio
CPT Code
DT diphtheria and tetanus toxoids, for individuals younger than seven years of age
DTaP (diphtheria, tetanus and acellular pertussis) for individuals younger than seven years of age
DtaP-HepB-IPV (diphtheria, tetanus toxoids, acellular pertussis, hepatitis B, and poliovirus), inactivated
DTaP-Hib (diphtheria, tetanus toxoids and acellular pertussis and hemophilus influenza B)
Hepatitis A, pediatric/adolescent, (2-dose schedule)
Hepatitis A, pediatric/adolescent, (3-dose schedule)
Hepatitis B vaccine, pediatric/adolescent dosage (3-dose schedule)
HepB-Hib, hepatitis B and hemophilus influenza b vaccine
Hib (hemophilus influenza B), HbOC conjugate
Hib, PRP-D conjugate, for booster only
Hib, PRP-OMP conjugate
Hib, PRP-T conjugate
Human papilloma virus (HPV), types 6, 11, 16, 18, (3-dose schedule)
90702
90700
90723
90721
90633
90634
90744
90748
90645
90646
90647
90648
90649
Influenza, intranasal
Influenza, split virus three years of age and above
Influenza, split virus, preservative free, six to 35 months of age
Influenza, split virus, preservative free, three years of age and above
Influenza, split virus, six to 35 months of age
Measles, mumps, rubella and varicella vaccine
Meningococcal polysaccharide conjugate, serogroups A,C,Y and W-135, 11-18 years of age
Meningococcal polysaccharide, two to 18 years of age
MMR (measles, mumps and rubella), live
Pneumococcal conjugate, polyvalent, children under five years of age
Poliovirus, inactivated, (IPV), subcutaneous
Poliovirus, live, (OPV), oral
Rotavirus vaccine, pentavalent, (3-dose schedule)
Td Tetanus and diphtheria toxoids adsorbed, for individuals seven years or older
Tetanus and diphtheria toxoids (Td), preservative-free, for individuals seven years and older
Tetanus toxoid adsorbed
Tetanus, diphtheria toxoids & acellular pertussis, for individuals seven years or older
Varicella (chickenpox), live
90660
90658
90655
90656
90657
90710
90734
90733
90707
90669
90713
90712
90680
90718
90714
90703
90715
90716
If you have any questions, please call our Customer Care Center at 1-866-896-6625.
Physician & Provider e-News, Vol. 1 2007
Features
Value-Added Benefits
No-Cost Services for Our Members
We want to help your patients strive for good health. One
way we do that is to offer services you generally will not see
in a traditional fee-for-service program. These are no-cost,
value-added benefits. Benefits and services are available
for members of our Healthy Start & Healthy Families
(HS&HF) program plan and the Aged, Blind, or
Disabled (ABD) plan.
postpartum visits as part of our prenatal program,
Healthy Habits Count for You and Your Baby. A gift
card to a local store is one incentive we may offer.
• Adult vision benefits. These benefits include annual
adult eye exams, frames and lenses for members 21 to
59 years of age. Contact VSP at 1-800-877-7195 for
more information.
Extras for our HS&HF Plan Members
• Transportation benefits. We offer members
transportation to Women, Infants and Children (WIC)
and County Department of Job and Family Services’
(CDJFS) redetermination appointments. Providers may
contact LogistiCare for transportation reservations of
Medicaid members at 1-866-883-8659.
• Sports physicals for children. We offer one free sports
physical per year for children who participate in
organized sports programs.
Extras for our ABD Plan Members
• Unlimited transportation. We provide unlimited
transportation to medical appointments, CDJFS
appointments and trips to the pharmacy to order or pick
up medicine. For transportation reservations, contact
LogistiCare at 1-866-907-1496.
We hope they encourage members to participate in regular
activities that lead to healthy living.
Please refer to our Provider Operations Manual for more
information on member benefits and services. If you have
any questions, please call our Customer Care Center at
1-866-896-6625 (HS&HF) or 1-866-896-6628 (ABD),
Monday through Friday, 7 a.m. to 7 p.m.
Value-Added Services for All Ohio Medicaid
Plan Members
• No copayments for office visits or prescriptions.
• Incentives for attending postpartum visits. We will
provide an incentive to members who complete their
Physician & Provider e-News, Vol. 1 2007
Features
Shedding Light on How to Help Smokers
1. Let members know that they can order a free
Handle Quitters-To-Be with a Lot of TLC
“I know. I know. I know.” You hear it all the time.
You hear it from those who admit to smoking despite
understanding of the costs to health, pocketbook and quality
of life. There’s not much you can do for smokers unfazed
by the consequences. For members who realize tobacco’s
negative impact and express the desire to quit for good, we
can help.
TLC Quit Kit. The TLC Quit Kit offers easy-to-
read smoking cessation strategies and tips members can comfortably incorporate in their daily lives.
The kit also has a day-by-day calendar magnet, national quit line flyer, a way to access telephonic counseling, personal action diary and flyer on
how to get Nicotine Replacement Therapy
(NRT). You can give members the TLC
Quit Kit. Simply send an e-mail request to [email protected] or call
our Customer Care Center at 1-866-896-6625.
Qualifying members who request a TLC Quit Kit
earn 1 point in our Healthy Returns 4 Healthy
Choices program.
We developed a smoking cessation program for our
members, called The Last Cigarette (TLC). This program
offers multiple tools and resources to assist smokers at
any stage of cessation. Its multi-faceted approach can help
smokers follow a plan of positive action.
As a physician who cares for our members, you can play a
big part in helping members take the first step to commit to
quit and take part in a smoking cessation program. Follow
these simple steps.
2.Tell members they can take a free stop-smoking Healthy Returns 4 Healthy Choices Pilot
class through our plan. Health Services offers smoking cessation classes to members at no cost! They can call the Customer Care Center phone number on their identification card for more information. Attending a stop-smoking class earns
2 points in the Healthy Returns 4 Healthy
Choices program.
of nicotine gum with brief clinical counseling can
help increase the effectiveness of intervention. You
should remind members that you can prescribe
generic gum/patch NRT, but they will need to fill the prescription at their pharmacy.
3. Prescribe NRT. Let members know it’s free. The use The pilot program in Northeast Ohio motivates patients
to proactively take charge of their health by providing
healthy rewards. Patients can earn value-added benefits
according to a points-based system for completing
specific healthy behaviors. Anthem will track each
patient’s progress until he or she earns 4 points, at which
time there is a choice between the following rewards:
4. Complete the Pregnancy Notification Report • 13 weeks of Weight Watchers® national program—FREE.
for expectant mothers who smoke. Pregnancy is
an optimum time to support cessation programs as women are more likely to quit and more likely to
remain smoke-free after the birth of a child. If you fill out a pregnancy notification report, we’ll
take it from there and send members prenatal
tobacco cessation information and resources. We also
will enroll them in classes and provide additional
support, if needed.
• The Healthy Returns gym bag full of fun and useful
health and fitness items.
Northeast Ohio patients can only be enrolled in this
program through your referral. And your qualifying
patients who participate in our TLC program (Quit
Kit and Stop Smoking classes) can earn up to 3 of the
needed 4 points. Your patients aren’t the only ones who
can earn rewards! As a physician, you can also earn a
$1,500 cash incentive if you are one of the top three
physicians who complete the most referrals to this
program! Incentives are rewarded every six months. To
learn more and find out if your patients quality for this
pilot, please call us at 1-800-319-0662.
5.Please refer members to call 1-800-QUIT NOW (1-800-784-8669). This free service offers one-on-
one telephonic support for members who want that personal guidance and a willing listener.
To learn more about The Last Cigarette program,
call Health Services at 1-800-319-0662. For smoking
cessation clinical practice guidelines, see “2007 Guidelines.”
Physician & Provider e-News, Vol. 1 2007
Policy and Benefits
Professional Provider Fee
Schedule Available
Information You Need Is Just a Keystroke Away
The new Ohio Medicaid Fee Schedule for the Healthy
Start & Healthy Families program and Aged, Blind,
or Disabled (ABD) program is available online. This
is a baseline fee schedule. To accurately determine
your reimbursement, please refer to your Medicaid
Amendment. If you have no Internet access, please e-mail
[email protected] to request a copy of the
current fee schedule. In the subject line, please refer to the
Ohio Fee Schedule CD. Also include your name, address
and phone number in the body of the e-mail.
Newborn Billing
Updated Provider Procedure
Getting the Newborn Medicaid ID
We’d like your help in getting newborn Medicaid ID
numbers added to the eligibility system. If you get the
newborn’s Medicaid ID number, please notify us. This
helps us pay you faster. If you know the newborn has
his/her own Medicaid ID, but you can’t find it in our
system, please complete a Newborn Notification Enrollment
Report form and send it to us. This will help us have the
most up-to-date records and allow us to pay you accurately.
Do not submit the claim using the newborn’s Medicaid ID
number until you see the number in our eligibility system
online (AccessPoint).
Anthem Partnership Plan wants to let you know that we
have improved our billing process for newborns. When an
Anthem Healthy Start & Healthy Families or Aged, Blind,
or Disabled (ABD) member has given birth, please bill us
using the mother’s Medicaid ID until the state has assigned
a permanent Medicaid ID number to the newborn, or, for
120 days after the baby’s date of birth, whichever comes first.
Please encourage the newborn’s parent or legal guardian to
contact the County Department of Job and Family Services
(CDJFS) to obtain a Medicaid ID number for the newborn.
Getting a Temporary ID
When we are notified of a baby’s birth, we issue a temporary
identification (ID) card similar to the one below. In the
Anthem ID No. field, we print a “Use Mother’s ID”
reminder message. As soon as we receive the newborn’s
Medicaid ID number, we update the member eligibility
verification system. Then we issue the newborn’s permanent
ID card with the Medicaid ID number. As soon as the
newborn’s Medicaid ID number is in our system, you can
submit claims for payment, using the newborn’s ID number.
Continue to submit your claim as you normally do – even
if you are using the mother’s Anthem ID number as the
newborn’s temporary ID number. It is not necessary for you
to submit the same claim electronically and on paper.
Physician & Provider e-News, Vol. 1 2007
Policy and Benefits
Prior Authorization and Eligibility Verification Waiver Period Ends
See our Comprehensive Prior Authorization List
At State Sponsored Business, we returned to our normal
member eligibility verification and prior authorization
practices June 1, 2007. You can view our Services Requiring
Prior Authorization, a comprehensive list of services that
require prior authorization.
member’s current regimen of care with an out-of-network
provider requires continuation, please contact our Customer
Care Center and ask to speak with a Care Manager for
authorization. For those members seeing out-of-network
providers, the provider must have prior authorization before
continuing to see that member.
Anthem complies with Ohio’s continuity of care
requirements. If a member or provider believes that a
Prior Authorization Toolkit
Download the Forms You Need
Need to request an important prior authorization? Now
it’s easy. The most frequently requested forms are on the
website in our Prior Authorization Toolkit. Just choose the
form you need to download. Complete the form and follow
instructions on where to call for authorization.
Looking for Answers?
Check Your Ohio Provider Operations
Manual (POM)
Your Ohio Provider Operations Manual (POM) is a
“one-stop” guide containing vital information to help
you better serve your Anthem Healthy Start & Healthy
Families program (HS&HF) and Aged, Blind, or Disabled
(ABD) members. The following is a brief summary of the
information, instructions and guidelines included in
the POM:
• Anthem provider forms
• Cultural and linguistic services
• Site review survey
• Member benefits
• Medical records standards
• Claims and billing
Verifying Member Eligibility
In addition, your Ohio POM has instructions and resources
for verifying member eligibility. For more information, see
Chapter 5, “Member Eligibility,” in your POM.
• Grievances and appeals
• Member enrollment
• Credentialing and recredentialing
Your Anthem Ohio POM is an easy-to-use, single PDF file
with enhanced navigation features.
• Care management
• Prior authorization
If you would like a copy on a CD, you can send an e-mail
to [email protected]. Or, you can call us
at 1-866-896-6625 (HS&HF) or 1-866-896-6628 (ABD),
Monday through Friday, 7 a.m. to 7 p.m.
• Utilization management
• Important state, county and Anthem telephone and fax
numbers, postal addresses, websites and e-mail addresses
Physician & Provider e-News, Vol. 1 2007
Policy and Benefits
2007 Guidelines Online
Find Critical Information and Updates
Links to the Clinical Practice Guidelines now are posted
and maintained online. You can find the links to the latest
guidelines covering:
Preventive Health Care Guidelines links also are posted
and maintained online. These guidelines are listed by age
and cover from birth to older adult, including maternity
guidelines. The links to preventive care resources provide
information to reinforce the importance of preventive
checkups, screenings and vaccinations.
• Asthma
• Behavioral health
• Chlamydia
Our plan-specific Utilization Management (UM)
Guidelines for determining what treatments are covered
under our plans also have been added to our website so you
can easily refer to them whenever you need to.
• Chronic heart failure
• Chronic obstructive pulmonary disease
• Coronary artery disease
If you would like a hard copy of any of these guidelines,
please call the Customer Care Center at 1-866-896-6625
(HS&HF) or 1-866-896-6628 (ABD).
• Diabetes
• High blood cholesterol
• Human Papilloma Virus
• Hypertension
• Obesity and overweight
• Hypertension
• Tobacco use
Physician & Provider e-News, Vol. 1 2007
Operations
How Quality Improvement Works
• Preventive health care services, examinations and
management of member health by physicians and other
health care providers.
What We Review
We have a systematic process in place to assess the quality
and appropriateness of care and service to our members.
This includes review of the following:
• Performance of all health plan programs.
For questions about our quality improvement process, please
contact our Customer Care Center at 1-866-896-6625
(Healthy Start & Healthy Families program) or
1-866-896-6628 (ABD).
• Care and service provided in all health delivery settings.
• Provider site facilities and patient medical records.
Medical Record Review Process
How to Comply with Policies
Medical record reviews are an important part of our Quality
Improvement Program. The reviews provide us with an
opportunity to ensure that the network physician offices
comply with the standards set for preventive care, obstetrical
care, and continuity and coordination of care.
Physician sites must achieve a score of 80 percent or greater
in each section of the review to pass. Physician sites scoring
less than 90 percent are required to implement corrective
actions to address deficiencies.
Medical Records Standards
The plan has established medical records standards that
require providers to maintain records in a manner that
is current and organized, and allows for effective and
confidential member care and quality review. We perform
an initial medical records review when a provider first
goes through our credentialing process. This ensures our
contracted providers are compliant with medical
records standards.
Storage
Providers should store active medical records in a central
office location that is secure and inaccessible to unauthorized
individuals. Medical record systems should allow prompt
retrieval of a medical record when a patient comes in for
an encounter.
Confidentiality
We expect providers to store and retrieve medical records
in a manner that protects patient information according
to the Confidentiality of Medical Information Act. This
act prohibits a health care provider from disclosing a
patient’s medical history, mental and/or physical condition
or treatment without the consent or legal authority of the
patient or his or her legal representative. Providers also
must comply with the security requirements of the Health
Insurance Portability and Accountability Act (HIPAA).
Continues
Physician & Provider e-News, Vol. 1 2007
Operations
Medical Record Review Process (Continued)
• Physical exams, treatment necessary and possible
risk factors for the member relevant to the
particular treatment.
Documentation
Every medical record should include:
• Prescribed medications, including dosages and dates of
initial or refill prescriptions.
• The patient’s name or ID number on each page in
the record.
• For patients 14 years of age and older, notation of
incidence and history of substance abuse, cigarette and
alcohol use (including anticipatory guidance and
health education).
• Personal biographical data.
– Home address.
– Employer information.
• Information on the individuals to whom you are
providing instructions for assisting patients.
– Emergency contact name and telephone number.
– Home and work telephone numbers.
• All entries complete with month, day and year date.
• Medical records that are legible, dated, signed by the
physician, physician assistant, nurse practitioner or
nurse midwife providing member care.
• All entries containing author identification (signature,
unique electronic identifier or initials) and title.
Including entries made by medical assistants.
• An up-to-date immunization record for children or an
appropriate immunization history in the medical record
for adults.
• Identification of all providers caring for the member and
information on services given by those providers.
• Evidence of preventive screens and services that meet
our preventive health care guidelines.
• A problem list, including significant illness and medical/
psychological conditions.
• Documentation of referrals, consultations, test results
and inpatient records. Notation of informing patients of
test results.
– Marital status.
• Presenting complaints, diagnoses and treatment plans,
plus services to be delivered.
• Notation of patient appointment cancellations or “no
show” and attempts to contact the patient to reschedule.
• Physical findings relevant to the visit (i.e., vital
signs, normal and abnormal findings, subjective
and objective information).
• No evidence that a member patient is placed at
inappropriate risk by a diagnostic or a
therapeutic procedure.
• Information on allergies and adverse reactions (or
notation of no known allergies or adverse reactions).
• Documentation of whether an interpreter was used. If
so, documentation that the interpreter also was used in
follow-up care.
• Documentation of the offer of information on
advance directives.
• Documentation of follow-up care needed.
• Past medical history, including serious accidents, operations
and illnesses. For children and adolescents – past medical
history relating to prenatal care, birth, operations and
childhood illnesses.
Physician & Provider e-News, Vol. 1 2007
Operations
How Utilization Management
Makes Decisions
Learn About Your Options
Our Utilization Management (UM) department provides
prospective, concurrent and retrospective reviews using
clinical criteria based on sound clinical evidence. Decisions
are based only on appropriateness of care and service, and
existence of coverage. We have developed medical policies
that provide guidance and support for medical necessity
determinations. The procedures and technologies described
in the policies are considered guidelines and are not intended
to imply benefit or coverage determinations for members.
Although a procedure or technology may be medically
necessary, it may be excluded in a member’s benefit plan. In
addition, benefit plans are subject to the laws and regulations
of the state and benefit determinations are made accordingly.
The medical policies are regularly reviewed, updated or
modified; therefore, they are subject to change. Benefit
determinations are made in the context of medical policies
existing at the time of the determination and are not subject
to later revision as a result of a change in medical policy.
To Talk about a UM Decision
You may call our physician-reviewers to talk about UM
decisions that you disagree with based on medical necessity.
To reach a physician-reviewer, contact the UM department
at 1-866-896-6580.
If a member disagrees with a medical necessity decision,
the member or an authorized representative may appeal
that decision by calling the Customer Care Center. This
phone number is printed on the member’s identification
card. UM encourages you, as physicians and providers, to
communicate freely with members regarding treatment
options available to them, including medication treatment
options, regardless of benefit coverage limitations. You
should know that we do not compensate anyone for denying
coverage or service, nor do we use financial incentives to
encourage denials or the underutilization of any needed
medical service.
To Reach UM
Staff members in our UM department are available to
answer your questions from 8 a.m. to 5 p.m. ET, Monday
through Friday. The UM department telephone number
is 1-866-896-6580. You may fax UM-related questions
and information to us anytime at 1-888-209-7838. A UM
representative will reply the next business day.
You also can call our Customer Care Center between 7 a.m.
and 7 p.m., Monday through Friday. For Healthy Start &
Healthy Families (HS&HF) program, call 1-866-896-6625.
For Aged, Blind, or Disabled (ABD), call 1-866-896-6628.
The TTY line is 1-800-750-0750. During business hours,
Customer Care Center representatives will transfer calls to
the UM department as necessary. After business hours and
on weekends and holidays, you can leave messages for UM
staff members at the Customer Care Center phone number.
A UM representative will return your call the next
business day.
MedCall Member Help Line
At any time of the day or night, you can reach the staff at
the MedCall nurse help line at 1-866-374-9480. The TTY
line is 1-800-368-4424. MedCall is a 24-hour help line
staffed by registered nurses who provide health management
information to members and providers. MedCall also can
provide member verification and eligibility information after
hours.
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Physician & Provider e-News, Vol. 1 2007
Health Improvement
Perform Initial Health Assessments
Be Sure to Meet the Mandate
Attention primary care providers: Be sure to perform a
complete history, physical examination and assessment of
health behaviors for all new members. Called an “initial
health assessment,” or IHA, this critical procedure
is mandatory.
make it easier for you to perform IHAs, we send you rosters
of new members who need IHAs or other preventive health
exams. Performing an IHA is key to identifying member
health problems early on and to building strong doctorpatient relationships.
It’s also an important part of the audit process. If you do
not complete this process, you are out of compliance. To
To learn more about mandated time frames for completing
IHAs, refer to your Provider Operations Manual.
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Physician & Provider e-News, Vol. 1 2007
Rx Updates
Prior Authorization of Benefits (PAB)
has been recognized for treatment of that condition by
one of the following:
Clarification and Requirements
• The American Medical Association
drug evaluations.
The PAB process for our prescription drug benefits alerts
prescribers about safe and less costly alternatives on the
formulary, as well as prescribed drugs that may not be
clinically recommended for the condition for which they are
prescribed. Keep in mind that certain medications on the
formulary and all nonformulary medications require
written PABs. Clarifications regarding PAB requirements:
• The American Hospital Formulary Service
drug information.
• The United States Pharmacopoeia Dispensing Information, Volume 1, “Drug Information for the Health Care Professional.”
•
1. Anthem covers medications that are medically
necessary. We defer to the prescribing physician’s
decision as long as the physician supplies medical
evidence that the drug is appropriate for a
patient’s condition.
2. We cover medications that require PAB and are
prescribed for off-label use in the treatment of an
illness, provided there is supporting medical evidence.
Supporting medical evidence validates a drug when it
Two articles from major peer-reviewed
medical journals presenting data that supports
the proposed off-label use(s) as generally safe
and effective. Along with this, no conflicting
evidence is presented in a major
peer-reviewed journal.
If we receive a request without the necessary information
to make a decision, we will request that the prescribing
physician provide us with additional medical information in
order to proceed with the review.
Generic Medications
A Cost-Effective Alternative
Educating patients on the use of generic medication is
a great way to reduce health care costs. Patients who
understand the equality of generic medicine to brand-name
counterparts most likely will convert to buying the former,
and at a much lower price.
same rigorous testing as their rivals, and are no different
when it comes to strength, dosage form, route of
administration or intended usage. Summed up, generic
products produce the same clinical effects and safety profiles
as brand-name medicines.
Overall, patients should be aware that generic drugs are
FDA-approved, and a safe, equally-effective alternative,
when clinically appropriate. Generic drugs require the
You can get a copy of our formulary at the Pharmacy
section of our website or by calling WellPoint NextRx at
1-800-227-3032.
If you want to reach us by phone:
STAT Physician & Provider e-News is published by Anthem Blue Cross Blue Shield
Partnership Plan, Inc. to serve our State Sponsored Business providers.
Customer Care Center: (HS&HF): 1-866-896-6625
Customer Care Center: (ABD): 1-866-896-6628
In Ohio, Anthem Blue Cross Blue Shield Partnership Plan, Inc. is an independent licensee
of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark. The
Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and
Blue Shield Association. Community Resource Centers:
Cleveland
Columbus
Toledo 1-866-757-8290
1-866-461-3581
1-866-915-3785
® WEIGHT WATCHERS is the registered trademark of Weight Watchers International,
Inc., and is used under license. 0307 OH0014616 8/07
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