ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. 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. Do not sell or share my personal information. In Indiana: Anthem Insurance Companies, Inc. Long-Term Care (LTC) Forms. 2022 Standard Pre-certification list . 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. Information to help you maximize your performance in our quality programs. 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). Use of the Anthem websites constitutes your agreement with our Terms of Use. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Start by choosing your patient's network listed below. Please check your schedule of benefits for coverage information. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Commercial Prior Authorization Summary and Code Lists Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Details about new programs and changes to our procedures and guidelines. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. For your convenience, we've put these commonly used documents together in one place. Independent licensees of the Blue Cross and Blue Shield Association. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 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. Summaries and code lists are posted as a reference to help you determine when prior authorization may be required for non-HMO government programs members. 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. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Please verify benefit coverage prior to rendering services. FEP Medications requiring online prior authorization, Intravenous Immune Globulin (IVIG) Therapy, Stereotactic Radiosurgery Using Gamma Rays, Surprise Billing - Out-Of-Network Provider Notice, Ambulance -elective air transport only (10.0.005), Behavioral Health and Substance Use Disorder (Milliman Care Guidelines), Repetitive Transcranial Magnetic Stimulation (TMS), Inpatient Behavioral Health and Substance Use Disorder, Home health care (Criteria defined in the employer group benefit contract), Home Infusion Therapy (Criteria defined in the employer group benefit contract), Hospice (Criteria defined in the employer group benefit contract), Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care), Maternity Services- inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract), Out-of-network services (Benefits available according to the member contract), Private Duty Nursing (Criteria defined in the employer group benefit contract), Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care). 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. 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. Forms and information about behavioral health services for your patients. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. PPO outpatient services do not require Pre-Service Review. In Maine: Anthem Health Plans of Maine, Inc. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. 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. Learn about the NAIC rules regarding coordination of benefits. Call our Customer Service number, (TTY: 711). Please verify benefit coverage prior to rendering services. Prior authorization requirement changes effective June 1, 2022 Mar 1, 2022 State & Federal / Medicare On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. To get started, select the state you live in. In Connecticut: Anthem Health Plans, Inc. This approval process is called prior authorization. You'll also find news and updates for all lines of business. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. Pharmacy Forms. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. Administrative. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. In 2020, Part B step therapy may apply to some categories . . 0
We look forward to working with you to provide quality services to our members. Start by choosing your patient's network listed below. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans These documents contain information about upcoming code edits. Please refer to the criteria listed below for genetic testing. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . 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). Updated June 02, 2022.
Providers should continue to verify member eligibility and benefits prior to rendering services. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. This new site may be offered by a vendor or an independent third party. 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. 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.). In Connecticut: Anthem Health Plans, Inc. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. 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. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. rationale behind certain code pairs in the database. Medical Clearance Forms and Certifications of Medical Necessity. These documents contain information about your benefits, network and coverage. ). To get started, select the state you live in. 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. For your convenience, we've put these commonly used documents together in one place. The purpose of this communication is the solicitation of insurance. Use of the Anthem websites constitutes your agreement with our Terms of Use. Large Group The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. We encourage providers to use Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. 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. This includes our Medicaid Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM(MA PPO) members. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. 494 0 obj
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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. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Anthem offers great healthcare options for federal employees and their families. Noncompliance with new requirements may result in denied claims. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Fax medical prior authorization request forms to: 844-864-7853
2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Third-Party Liability (TPL) Forms. 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. With three rich options to choose from, weve got you covered. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. 711. 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. 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. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Forms and information to help you request prior authorization or file an appeal. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. 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. You can also check status of an existing request and auto-authorize more than 40 common procedures. Please check your schedule of benefits for coverage information. This list contains notification/prior authorization requirements for inpatient and outpatient services. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. PPO outpatient services do not require Pre-Service Review. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. You can also refer to the provider manual for information about services that require prior authorization. Effective 01/01/2023 (includes changes effective 04/01/2023) . Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). endstream
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Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. 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. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. 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. Bundling Rationale (Claims filed before Aug. 25, 2017). Future updates regarding COVID-19 will appear in the monthly Provider News publication. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) Some procedures may also receive instant approval. 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. 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