1. Anthem Healthy Indiana Plan (HIP)
State Sponsored Business

2. Plan Overview Covered Services Physician Services Prescriptions
           
*Unlimited
Preventive
Care
Covered Services
Physician Services
Prescriptions
Diagnostic Exams
Disease Management
Home Health Services
Outpatient Hospital
Inpatient Hospital
Smoking Cessation
Prostate Exam
Diabetes
Mammogram
Physical
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
*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.

3. Covered Benefits Physician Care
PMPs within 30 miles and specialty providers within 60 miles of each member
Pharmacy
-Minimum of generics covered in each drug class
-Brand name coverage for drugs without a generic version
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
Out of Network Services
-OON services are covered only when a prior authorization is obtained.
-Exceptions are Emergency and Family Planning
Specialized Services
-In and outpatient hospital
-Emergency services
-Disease management
-Diagnostic services
-Home health

4. 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

5. 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.

6. Claims Information Anthem Member Identification Card
Alpha Prefix YRK with unique ID# from Anthem ID Card
Electronic Claims to Anthem
Anthem Payor ID: Professional and – Institutional
Claims Filing Address:
PO Box 37010
Louisville, KY
Follow Anthem Commercial Filing/Billing Requirements
180 Day Claim Filing Time Limit
Applies to both Professional and Institutional claims
Same as Anthem Commercial
HIP claims included on Commercial Vouchers/Remittance Advice

7. New HIP ID Card
The applicable ER copays are $3.00, $6.00 or $25.00 for parents based on Federal Poverty Level (FPL).
<100% FPL - $3.00,
% FPL-$6.00,
% - $25.00
Childless Adult = $25.00 copay

8. Important Phone Numbers
Provider Phone Numbers
Provider Inquiry:
Credentialing/Contract Info:
Benefits and Eligibility:
Prior Authorization/Utilization Management:
Radiology Prior Authorizations:
Behavioral Health Authorizations: Option 3
Cost Containment (Refunds/Recovery):
Prior Authorization Pharmacy:
Anthem Fraud and Abuse:
Pharmacist Services:
Member Phone Numbers
Healthy Indiana Plan Call Center:
1-877-GET-HIP-9
Member Benefits and Eligibility:
Member Customer Service:
Member 24-Hour Nurse Assist Line:

9. Website Information MyAnthem™ 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
Claims Filing Information