Please check your schedule of benefits for coverage information. We also support our providers with access to information about our plans and member benefits, news and updates, training materials and guides and other helpful resources. We encourage providers to use ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). In Indiana: Anthem Insurance Companies, Inc. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Anthem offers great healthcare options for federal employees and their families. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. February 2023 Anthem Provider News - Virginia, New ID cards for Anthem Blue Cross and Blue Shield members - Virginia, Telephonic-only care allowance extended through April 11, 2023 - Virginia, January 2023 Anthem Provider News - Virginia, December 2022 Anthem Provider News - Virginia, Medicare Advantage Providers | Anthem.com, March 2022 Anthem Provider News - Virginia, K1022 Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. Independent licensees of the Blue Cross and Blue Shield Association. Type at least three letters and well start finding suggestions for you. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. It clarifies a utilization management vendor change for specific members. 451 0 obj
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Administrative. Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. In Virginia, CareFirst MedPlus and CareFirst Diversified Benefits are is the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. CoverKids. endstream
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<. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Or In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. CareFirst does not guarantee that this list is complete or current. Any drugs, services, treatment, or supplies that the CareFirst medical staff determines, with appropriate consultation, to be experimental, investigational or unproven are not covered services. Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services (CMS) guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. We look forward to working with you to provide quality service for our members. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Contact 866-773-2884 for authorization regarding treatment. Please refer to the criteria listed below for genetic testing. National Accounts, Posts about using health Insurance and managing your health, Collections of learning resources and links to services, For Sydney Health users connect with others and find care programs. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). 2022 Standard Pre-certification list . Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. Select Patient Registration from the top navigation. Providers should continue to verify member eligibility and benefits prior to rendering services. Please verify benefit coverage prior to rendering services. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Medicare Advantage. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Use of the Anthem websites constitutes your agreement with our Terms of Use. In 2020, Part B step therapy may apply to some categories . Medicare Coverage with Anthem Medicare Information Medicare Coverage and Enrollment Turning 65 Medicare Advantage Plans: Part C Medicare Part D Plans Medicare Supplement Plans (Medigap) Dental and Vision Coverage CareCare What to Know Getting Better Care Preventive Health Find Care Medicare Caregiver Resources SupportSupport Login Registration Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Online - The AIM ProviderPortal is available 24x7. The services marked with an asterisk (*) only require Pre-Service Review for members enrolled in BlueChoice products if performed in an outpatient setting that is on the campus of a hospital. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). CareFirst Medicare Advantage requires notification/prior authorization of certain services. Create your signature and click Ok. Press Done. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), whichunderwrites or administersthe PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwritesor administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Select Auth/Referral Inquiry or Authorizations. Learn about the NAIC rules regarding coordination of benefits. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. We look forward to working with you to provide quality services to our members. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. The latest edition and archives of our monthly provider newsletter. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. One option is Adobe Reader which has a built-in reader. You'll also find news and updates for all lines of business. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Independent licensees of the Blue Cross Association. Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Access eligibility and benefits information on the Availity Web Portal or Use the Prior Authorization Lookup Tool within Availity or Contact the Customer Care Center: Outside Los Angeles County: 1-800-407-4627 Inside Los Angeles County: 1-888-285-7801 Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. Prior Authorization. In addition, some sites may require you to agree to their terms of use and privacy policy. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Anthem HealthKeepers Plus Provider Manual, Long-term Services and Supports Authorization Guide. ). Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. For costs and complete details of the coverage, please contact your agent or the health plan. Providers are responsible for verifying prior authorization requirements before services are rendered. Fax medical prior authorization request forms to: 844-864-7853
Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Choose My Signature. Code Bundling Rationale 2017 Q3 CPT Codes, Code Bundling Rationale 2017 Q2CPT Codes, Code Bundling Rationale 2017 Q1CPT Codes, Code Bundling Rationale 2016 Q4CPT Codes, Code Bundling Rationale 2016 Q3CPT Codes, Code Bundling Rationale 2016 Q2CPT Codes, Code Bundling Rationale 2016 Q1CPT Codes, Code Bundling Rationale 2015 Q4CPT Codes, Code Bundling Rationale 2015 Q3CPT Codes, Code Bundling Rationale 2015 Q2CPT Codes, Code Bundling Rationale 2015 Q1CPT Codes, Code Bundling Rationale 2014 Q4CPT Codes, Code Bundling Rationale 2014 Q3CPT Codes, Code Bundling Rationale 2014 Q2CPT Codes, Code Bundling Rationale 2014 Q1CPT Codes, Code Bundling Rationale 2013 Q4CPT Codes, Code Bundling Rationale 2013 Q3CPT Codes, Code Bundling Rationale 2013 Q2CPT Codes, Code Bundling Rationale 2013 Q1CPT Codes, Code Bundling Rationale 2012 Q4CPT Codes, Code Bundling Rationale 2012 Q3CPT Codes, Code Bundling Rationale 2012 Q2CPT Codes, Code Bundling Rationale 2012 Q1CPT Codes, Code Bundling Rationale 2011 Q4CPT Codes, Code Bundling Rationale 2011 Q3CPT Codes, Code Bundling Rationale 2011 Q2CPT Codes, Code Bundling Rationale 2011 Q1CPT Codes, Code Bundling Rationale 2010 Q4CPT Codes, Code Bundling Rationale 2010 Q3CPT Codes, Code Bundling Rationale 2010 Q2CPT Codes, Code Bundling Rationale 2010 Q1CPT Codes, 1998-document.write(new Date().getFullYear()); BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. For your convenience, we've put these commonly used documents together in one place. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Forms and information to help you request prior authorization or file an appeal. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. With three rich options to choose from, weve got you covered. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Type at least three letters and well start finding suggestions for you. Providers should call the prior authorization number on the back of the member ID card. . Musculoskeletal (eviCore): 800-540-2406. Expedited fax: 888-235-8390. Contact 866-773-2884 for authorization regarding treatment. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Here youll find information on the available plans and their benefits. The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. Use of the Anthem websites constitutes your agreement with our Terms of Use. Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. Call our Customer Service number, (TTY: 711). Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Please Select Your State The resources on this page are specific to your state. Medical Injectable Drugs: 833-581-1861. Updated June 02, 2022. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. As your health needs evolve, our diverse plans are designed to evolve with you. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. February 2023 Anthem Provider News - Missouri, New ID cards for Anthem Blue Cross and Blue Shield members - Missouri, Telephonic-only care allowance extended through April 11, 2023 - Missouri, January 2023 Anthem Provider News - Missouri, December 2022 Anthem Provider News - Missouri, November 2021 Anthem Provider News - Missouri. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. After hours, verify member eligibility by calling the 24/7 NurseLine at. The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 0
cost of services to the member if denied by Anthem for lack of medical necessity: (1) Procedures, equipment, and/or specialty infusio n drugs which have medically necessary criteria determined by Corporate Medical Policy or Adopted Clinical Guidelines. Nov 1, 2021 The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Ohio: Community Insurance Company. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. The purpose of this communication is the solicitation of insurance. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. In Indiana: Anthem Insurance Companies, Inc. Medicaid Behavioral/Physical Health Coordination. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. This tool is for outpatient services only. Rx Prior Authorization. CareFirst Commercial Pre-Service Review and Prior Authorization. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Do not sell or share my personal information. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual. These manuals are your source for important information about our policies and procedures. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. Information to help you maximize your performance in our quality programs. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Providers should continue to verify member eligibility and benefits prior to rendering services. HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. In the event of an emergency, members may access emergency services 24/7. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. 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