The latest edition and archives of our quarterly quality newsletter. Please verify benefit coverage prior to rendering services. PPO outpatient services do not require Pre-Service Review. BCBS FEP Vision covers frames, lenses, and eye exams. Inpatient services and nonparticipating providers always require prior authorization. 451 0 obj
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The site may also contain non-Medicare related information. 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. Providers should continue to verify member eligibility and benefits prior to rendering services. 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. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Contact will be made by an insurance agent or insurance company. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. endstream
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<. Provider Enrollment Forms. The clinical editing rationale supporting this database is provided here to assist you in understanding the These manuals are your source for important information about our policies and procedures. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . We look forward to working with you to provide quality services to our members. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Forms and information about pharmacy services and prescriptions for your patients. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. In Ohio: Community Insurance Company. Inpatient services and nonparticipating providers always require prior authorization. For costs and complete details of the coverage, please contact your agent or the health plan. The purpose of this communication is the solicitation of insurance. 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. Some procedures may also receive instant approval. To view this file, you may need to install a PDF reader program. Choose My Signature. 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. For more information, please refer to the Medical Policy Reference Manual. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . Decide on what kind of signature to create. In Kentucky: Anthem Health Plans of Kentucky, Inc. Forms and information about behavioral health services for your patients. Get the latest news to help improve your life and keep you healthy. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Code pairs reported here are updated quarterly based on the following schedule. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. It clarifies a utilization management vendor change for specific members. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. 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. 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). Look up common health coverage and medical terms. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. 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. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. 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. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. In Maine: Anthem Health Plans of Maine, Inc. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. 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 844-912-0938 Email: [email protected] 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 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. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. 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. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. For your convenience, we've put these commonly used documents together in one place. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 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. Fax medical prior authorization request forms to: 844-864-7853
Large Group 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. 477 0 obj
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Call our Customer Service number, (TTY: 711). Medicare Advantage. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. 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. Or Updated June 02, 2022. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. PPO outpatient services do not require Pre-Service Review. 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. 0
Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Third-Party Liability (TPL) Forms. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. 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. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. 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. 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. 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. To get started, select the state you live in. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Select Auth/Referral Inquiry or Authorizations. hb``` ce`a`Y5
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In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. endstream
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For your convenience, we've put these commonly used documents together in one place. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Independent licensees of the Blue Cross Association. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) Details about new programs and changes to our procedures and guidelines. Scroll down to the table of contents. In Kentucky: Anthem Health Plans of Kentucky, Inc. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Please note: This change is not applicable to the members enrolled in the Mercy Co-worker Plan as they have a customized prior authorization list. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. In the event of an emergency, members may access emergency services 24/7. 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. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Musculoskeletal (eviCore): 800-540-2406. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Ohio: Community Insurance Company. 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. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Information to help you maximize your performance in our quality programs. Medical Clearance Forms and Certifications of Medical Necessity. 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 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. In Indiana: Anthem Insurance Companies, Inc. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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. Do not sell or share my personal information. 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. Type at least three letters and well start finding suggestions for you. 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. You'll also find news and updates for all lines of business. Availity provides administrative services to BCBSIL. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. 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. 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. Commercial Prior Authorization Summary and Code Lists This approval process is called prior authorization. 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 Independent licensees of the Blue Cross and Blue Shield Association. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Providers should continue to verify member eligibility and benefits prior to rendering services. 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. 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). Effective 01/01/2023 (includes changes effective 04/01/2023) . To get started, select the state you live in. The latest edition and archives of our monthly provider newsletter. Most PDF readers are a free download. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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. Noncompliance with new requirements may result in denied claims. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Please verify benefit coverage prior to rendering services. Information about benefits for your patients covered by the BlueCard program.
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. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Inpatient Clinical: 800-416-9195. Prior Authorization. Here you'll find information on the available plans and their benefits. Start by choosing your patient's network listed below. Referencing the . In addition, some sites may require you to agree to their terms of use and privacy policy. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Create your signature and click Ok. Press Done. With three rich options to choose from, weve got you covered. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. 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