Transcript Third Party Billing

California Human Development
Outpatient Treatment
Santa Rosa, CA
Change Team Members:
Dana Alvarez
Tina Millis
Angie Tapia
Start Date: 4/1/2012
End Date: 10/9/2012
AIM
INCREASE THE NUMBER OF INSURANCE CLAIMS SENT TO
ANTHEM PATH2HEALTH FROM 0-1

Complete the Anthem Agreement application and submitted.

Called on a weekly basis to inquire on application status

Viewed the Webinar orientation

Finally learned CHD was an contracted drug and alcohol provider of Anthem (following Supreme
Court ruling) Learned this through an email from the person taking the place of our Anthem contact
while he was on vacation

Set up a group for CMSP clients on Thursday evening (capped at 8 participants)

Began enrolling CMSP participants (using the medi-cal site confirmed CMSP eligibility)
AIM
INCREASE THE NUMBER OF INSURANCE CLAIMS SENT TO
ANTHEM PATH2HEALTH FROM 0-1

County SWITS administrator set up the CMSP payor group on SWITS; counselor created encounters but did not
release given we had not received the authorization at this point

Completed and faxed two forms: 1 Data Sharing 2. The OTR (emailed our original contact with many questions –
sometimes we would get a response and other times not)

Waited for responses – at least two weeks

Received an authorization on one person and then another

Dates and number of sessions differed on these authorizations (an Anthem representative adjusted dates and sessions
while informing us how to input the data (codes) – Now had a Anthem contact!!!

Completed SWITS authorization record and released encounters.

Batched encounters, printed 1500 forms (six claims) and sent to address given for claims
Results
CHD increased the number of insurance claims sent to
Anthem Path2Health From “0” To “6”
(actual measurement achieved) by September 15, 2012.
October 4, 2012 received a check in the amount of $125
for one claim.
Next
Steps
Impact