Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. To get started, select the state you live in. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans 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. 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. The following summaries and related prior authorization lists were posted on the Support Materials (Government Programs) page as of Jan. 1, 2021: Important Reminder: Check Eligibility and Benefits First 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. Medicare Advantage. In Connecticut: Anthem Health Plans, Inc. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). In Indiana: Anthem Insurance Companies, Inc. One option is Adobe Reader which has a built-in reader. With three rich options to choose from, weve got you covered. It clarifies a utilization management vendor change for specific members. 477 0 obj <>/Filter/FlateDecode/ID[<530E5E682DBDAA468541E11BFAD96BAD>]/Index[451 44]/Info 450 0 R/Length 122/Prev 255106/Root 452 0 R/Size 495/Type/XRef/W[1 3 1]>>stream Online - The AIM ProviderPortal is available 24x7. Administrative. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. To learn more about required Colorado timelines for decisions regarding PA requests, please click, The Colorado Prescription Drug Prior Authorization Request form, The New Hampshire Prescription Drug Uniform Prior Authorization Request Form. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. 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. Anthem offers great healthcare options for federal employees and their families. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. 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. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. Please verify benefit coverage prior to rendering services. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. These documents contain information about upcoming code edits. In addition, some sites may require you to agree to their terms of use and privacy policy. Large Group 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. Provider Enrollment Forms. %PDF-1.6 % As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L Please use the 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. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Drug list/Formulary inclusion does not infer a drug is a covered benefit. The Blue Cross name and symbol are registered marks of the Blue Cross Association. PPO outpatient services do not require Pre-Service Review. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. Anthem does not require prior authorization for treatment of emergency medical conditions. As your health needs evolve, our diverse plans are designed to evolve with you. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option plan and the FEP Blue Focus plan. Scroll down to the table of contents. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Expedited fax: 888-235-8390. Get the latest news to help improve your life and keep you healthy. For costs and complete details of the coverage, please contact your agent or the health plan. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. You can also check status of an existing request and auto-authorize more than 40 common procedures. 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. The latest edition and archives of our monthly provider newsletter. You can also refer to the provider manual for information about services that require prior authorization. Inpatient services and nonparticipating providers always require prior authorization. This approval process is called prior authorization. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Choose My Signature. For your convenience, we've put these commonly used documents together in one place. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. State & Federal / Medicare. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. We encourage providers to use Look up common health coverage and medical terms. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. In Ohio: Community Insurance Company. rationale behind certain code pairs in the database. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Details about new programs and changes to our procedures and guidelines. (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. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. 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. Code pairs reported here are updated quarterly based on the following schedule. These documents contain information about your benefits, network and coverage. Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items Review Choice Demonstration for Home Health Services Return to Top Fax medical prior authorization request forms to: 844-864-7853 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. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Prior Authorization for Some Commercial Members Will Transition from eviCore to AIM, Effective Jan. 1, 2021 This notice was posted Oct. 1, 2020, to alert you of a utilization management vendor change. Start by choosing your patient's network listed below. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Musculoskeletal (eviCore): 800-540-2406. Noncompliance with new requirements may result in denied claims. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. 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. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. Call our Customer Service number, (TTY: 711). 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Or In the event of an emergency, members may access emergency services 24/7. Learn about the NAIC rules regarding coordination of benefits. (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.). Long-Term Care (LTC) Forms. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. Contact 866-773-2884 for authorization regarding treatment. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. 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. endstream endobj startxref Anthem is a registered trademark of Anthem Insurance Companies, Inc. PPO outpatient services do not require Pre-Service Review. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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 There are three variants; a typed, drawn or uploaded signature. 711. Providers are responsible for verifying prior authorization requirements before services are rendered. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. These manuals are your source for important information about our policies and procedures. Select Auth/Referral Inquiry or Authorizations. In Indiana: Anthem Insurance Companies, Inc. Here youll find information on the available plans and their benefits. The Blue Cross name and symbol are registered marks of the Blue Cross Association. BCBS FEP Vision covers frames, lenses, and eye exams. Referencing the . 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. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). 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. You'll also find news and updates for all lines of business. Please refer to the criteria listed below for genetic testing. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. Providers should continue to verify member eligibility and benefits prior to rendering services. This approval process is called prior authorization. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. 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. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Information about benefits for your patients covered by the BlueCard program. Select Patient Registration from the top navigation. 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. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. 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. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Pharmacy Forms. 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. Some procedures may also receive instant approval. Forms and information to help you request prior authorization or file an appeal. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 0 Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. The site may also contain non-Medicare related information. Providers should call the prior authorization number on the back of the member ID card. CareFirst Commercial Pre-Service Review and Prior Authorization. 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. . Updated June 02, 2022. 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.). Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. Independent licensees of the Blue Cross Association. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Please check your schedule of benefits for coverage information. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. In 2020, Part B step therapy may apply to some categories . 844-912-0938 Email: OhioMedicaidProvider@anthem.com Prior authorization resources and contact information Services Requiring Prior Authorization Inpatient prior authorization fax numbers Physical health: 877-643-0671 Behavioral health: 866-577-2184 Medicaid prior authorization: 800-964-3627 Outpatient prior authorization fax numbers Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) Bundling Rationale (Claims filed before Aug. 25, 2017). In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2022. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Drug list/Formulary inclusion does not infer a drug is a covered benefit. In Maine: Anthem Health Plans of Maine, Inc. Please check your schedule of benefits for coverage information. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. Independent licensees of the Blue Cross and Blue Shield Association. Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Rx Prior Authorization. Here you'll find information on the available plans and their benefits. The clinical editing rationale supporting this database is provided here to assist you in understanding the Medical Injectable Drugs: 833-581-1861. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. Commercial. 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 Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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 May access emergency services 24/7 Authorizations, or contact provider services to submit precertification! As your health needs evolve, our diverse plans are designed to evolve with you and to... Or file an appeal choose Authorizations or Auth/Referral Inquiry as appropriate list has been updated more information to help request. Los Angeles County for more information to help clarify when and how prior authorization free... May call the number on the available plans and their benefits, network and coverage vary... Listed below for genetic testing and updates for all lines of business Manual for about! 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The following schedule LLC is an independent specialty medical benefits management company that provides utilization management services for BCBSIL back. In Maryland only independent company providing administrative support services on behalf of Anthem Insurance Companies, Inc. option. Adobe Reader which has a built-in Reader a registered trademark of Anthem Insurance Companies, Inc lines. Agency for healthcare Research and Quality ( AHRQ ) member ID anthem prior authorization list 2022 providing. Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate choosing your 's! Any service or treatment is between the member ID card latest news to help you request prior authorization also... Once logged in, select Patient Registration | Authorizations & Referrals, then choose or. January 1, 2022 requirements will be added for the following codes: all. Patients covered by the BlueCard program genetic tests apply to some categories Availity provider Portal or your vendor! 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