Q1 2024 PROVIDER NEWSLETTER

Date: 03/25/24

Current Membership

We are very excited to announce that our Ambetter marketplace membership surpassed 50,000 for our first year in the great state of Alabama. Open enrollment 2024 has seen our membership continue to grow as we expanded into 12 new counties for a total of 39 in our current service area. Raspberry counties reflect our service area from 2023 and blue counties are where we expanded in 2024. 

With this growth comes great responsibility and we’re deeply appreciative of our provider community partnership as we build a best-in-class health plan for the residents of Alabama. 

A current roster with accurate practitioner data, addresses, and phone numbers is critical to the member and provider experience. Has your practice roster changed? By sharing your complete roster along with any modifications, we can promptly submit the changes to ensure our directory accurately reflects your current provider roster. This method guarantees no updates are overlooked.

We’re looking forward to continuing to build relationships with our provider network. If you have any questions, please feel free to contact us.

Community Collaboration

We are proud to connect with the communities we serve and look forward to building more long-term relationships in the future.

• Studio53 Women’s Expo on 3/24/24 in Huntsville, AL 
• Jefferson County Broker sponsored Network Senior Services Luncheon on 4/9/24 in Birmingham, AL
• Network Forum (AL Primary Health Care Association) on 5/15-5/16 in Opelika, AL 
• Alabama AIDS Community Health Fair on 6/22/24 in Mobile, AL
• Annual Summer Conference (AAHP) on 7/29-7/31 in Fairhope, AL 
• Annual Conference & Expo (AL Primary Health Care Association) on 10/29-10/31 in Gulf Shores, AL

Provider Resources 

On the Ambetter of Alabama website, you are able to scroll down to find a variety of resources such as the Provider & Billing Manual, Quality Improvement & Risk Adjustment documents, Prior Authorization forms, and Behavioral Health information. Cultural Humility & Health Equity resources.

In addition to a variety of documents & resources mentioned above, we also made it easy to email the right department for the right reason. We hope listing these email addresses makes it easy for you to contact the right person.

Contact us for updates to pre-existing contracts, requests to add/term practitioners and data maintenance/enrollments.

Just a friendly reminder that including the taxonomy is crucial for clean claim submissions for Ambetter. Ensuring this step is completed can help streamline the process and avoid any unnecessary claim rejections and delays.

Quality & NCQA

Ambetter of Alabama is dedicated to quality measurement and improvement of health plan operations to drive positive outcomes for high quality health care and services. 

To realize our goal of being the preferred Marketplace carrier in Alabama, we will be going through our first Health Plan Accreditation survey with the National Committee for Quality Assurance (NCQA) later this year. 

The NCQA process will measure our commitment to excellence in the following standards:

• Quality Management and Improvement
• Population Health Management
• Network Management
• Utilization Management
• Credentialing and Re-credentialing
• Member Experience
  

Billing & Clinical Policy Updates

Clinical and Payment policies are one set of guidelines used to assist in administering health plan benefits and processing payments. See a comprehensive list of our Clinical and Payment Policies.

HEDIS & Risk Adjustment

Ambetter of Alabama is currently active for both the HEDIS and Risk Adjustment chart chase projects. The HEDIS Hybrid Project runs from late January through April annually. Risk Adjustment Chart Chase runs from October through April. Your active participation in these projects is crucial for accurate data collection and to improve quality care outcomes. We ask that you please prioritize the medical record requests which will be coming from the vendors listed. Here's to a successful chart chase season!

Retrieval Vendors in use:

• Datafied
• Ciox (Datavant)

As a cherished part of our network, your role in caring for our members is crucial. Ambetter of Alabama stands beside you, offering insights to empower you to deliver exceptional care. This form shared is a part of our Quality Improvement (QI) Program, a thoughtful initiative focused on enhancing the quality and safety of services you provide to your patients and our members.

MSK Management Program

Ambetter of Alabama is committed to continuously improving services for its members. Effective March 1, 2024, we've partnered with National Imaging Associates, Inc. (NIA) for a Musculoskeletal (MSK) Management Program. This program requires prior authorization for non-emergent MSK procedures, including outpatient procedures, interventional pain management services, and select surgeries. This aligns with industry efforts to ensure quality of care and manage the growing usage of these services. 

2024 Provider Orientation Deck (PDF)

Appointment Availability & Wait Times

APPOINTMENT AVAILABILITY & WAIT TIMES

Ambetter follows the accessibility and appointment wait time requirements set forth by applicable regulatoryand accrediting agencies. Ambetter monitors participating provider compliance with these standards at leastannually and will use the results of appointment standards monitoring to ensure adequate appointmentavailability and access to care and to reduce inappropriate emergency room utilization. The table belowdepicts the appointment availability for members: 

• Please utilize all features & functions found in our Ambetter of AL website.
• Remember to contact your Provider Engagement Administrator with any demographic updates.
• Providers can create an account or login to our portal.