Our resources vary by state. The resources for our providers may differ between states. Enter a Current Procedural Terminology (CPT) code in the space below to get started. You can also visit. Apr 1, 2022 Use the Prior Authorization tool within Availity OR. Available for iOS and Android devices. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. New member? Explore programs available in your state. Find answers to all your questions with an Anthem representative in real time. 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. It looks like you're outside the United States. 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., 2023. out of your benefits, find the best healthcare, and stay healthy. Provider Medical Policies | Anthem.com Find information that's tailored for you. Our resources vary by state. We want to help physicians, facilities and other health care professionals submit claims accurately. Your online account is a powerful tool for managing every aspect of your health insurance plan. Understand your care options ahead of time so you can save time and money. Type at least three letters and we will start finding suggestions for you. Find a Medicare plan that fits your healthcare needs and your budget. If youre concerned about losing coverage, we can connect you to the right options for you and your family. 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. Health equity means that everyone has the chance to be their healthiest. This tool is for outpatient services only. Make your mental health a priority. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Choose your state below so that we can provide you with the most relevant information. Please verify benefit coverage prior to rendering services. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. Out-of-state providers. 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). Inpatient services and nonparticipating providers always require prior authorization. Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment, Indiana Medicaid Prior Authorization Requirements List, New Option Available for Indiana Market. Medical policies can be highly technical and complex and are provided here for informational purposes. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. Choose your location to get started. Reaching out to Anthem at least here on our. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. You can also type part of the code's description to search, for example type "tonsil" to find "Removal of tonsils." This tool can be used to check if a prior authorization is required for health care services covered by Blue Cross and Blue Shield of Minnesota commercial health plans, Medicare Advantage and Platinum Blue. We currently don't offer resources in your area, but you can select an option below to see information for that state. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Our resources vary by state. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. We look forward to working with you to provide quality service for our members. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Access eligibility and benefits information on the Availity* Portal OR. 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. Search by keyword or procedure code for related policy information. Once youve accessed the Precertification Lookup Tool, choose a line of business from the menu selection offered, and then type the CPT/HCPCS code or a code description to determine if a prior authorization is required. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. The notices state an overpayment exists and Anthem is requesting a refund. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Find drug lists, pharmacy program information, and provider resources. You can also visit bcbs.com to find resources for other states. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. Type at least three letters and well start finding suggestions for you. Anthem is a registered trademark of Anthem Insurance Companies, Inc. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. 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., 2023. You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed. JavaScript is disabled. 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. Explore our resources. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Your dashboard may experience future loading problems if not resolved. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). These guidelines do not constitute medical advice or medical care. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. Please update your browser if the service fails to run our website. 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. 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. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Our research shows that subscribers using Codify by AAPC are 33% more productive. Anthem offers great healthcare options for federal employees and their families. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare, Keyword database enhanced with medical acronyms and terminology, Default settings to lock in your preference for code-centered or range pages, Code Constructor to narrow down your code options one clickable range at a time, Lay terms and CPT code update information, An expanded index by service eases looking for a procedure or service. Copyright 2023. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. There is no cost for our providers to register or to use any of the digital applications. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Independent licensees of the Blue Cross and Blue Shield Association. Click Submit. 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. 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. After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-224-0336. Use our app, Sydney Health, to start a Live Chat. We look forward to working with you to provide quality service for our members. Choose your location to get started. We currently don't offer resources in your area, but you can select an option below to see information for that state. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. In Indiana: Anthem Insurance Companies, Inc. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. 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. Directions. The resources for our providers may differ between states. Quickly and easily submit out-of-network claims online. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. Your browser is not supported. Please verify benefit coverage prior to rendering services. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Select Auth/Referral Inquiry or Authorizations. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. E0731 Conductive garment for Tens G0460 Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment L3000 Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each Inpatient services and nonparticipating providers always require prior authorization. Understand your care options ahead of time so you can save time and money. Prior Authorization Lookup. State & Federal / Medicaid. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. Were committed to supporting you in providing quality care and services to the members in our network. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. We currently don't offer resources in your area, but you can select an option below to see information for that state. Find drug lists, pharmacy program information, and provider resources. Contact will be made by an insurance agent or insurance company. Please note: This tool is for outpatient services only. Medicare Complaints, Grievances & Appeals. The doctors, hospitals, and other providers which are part of the network of providers referred to in this document are independent contractors who exercise independent judgment and over whom we have no control or right of control. Administrative / Digital Tools, Learn more by attending this live webinar. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Audit reveals crisis standards of care fell short during pandemic. 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. Select Your State The resources for our providers may differ between states. Access your member ID card from our website or mobile app. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manualand support for delivering benefits to our members. Choose your state below so that we can provide you with the most relevant information. Do not sell or share my personal information. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. We currently don't offer resources in your area, but you can select an option below to see information for that state. We look forward to working with you to provide quality services to our members. 711. Enter one or more keyword (s) for desired policy or topic. Use of the Anthem websites constitutes your agreement with our Terms of Use. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. It does not reflect benefits coverage, nor does it include an exhaustive listing of all non-covered services (in other words, experimental procedures, cosmetic surgery, etc.). 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. A group NPI cannot be used as ordering NPI on a Medicare claim. In Kentucky: Anthem Health Plans of Kentucky, Inc. Call Provider Services at 1-800-454-3730 (TTY 711) After hours, verify member eligibility by calling the 24/7 Nurse HelpLine at 1-800-600-4441. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. For a better experience, please enable JavaScript in your browser before proceeding. It looks like you're outside the United States. Please note that services listed as requiring precertification may not be covered benefits for a member. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. If this is your first visit, be sure to check out the. The medical policies do not constitute medical advice or medical care. ET. Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. If your state isn't listed, check out bcbs.com to find coverage in your area. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. The resources for our providers may differ between states. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. The resources for our providers may differ between states. Enter a CPT or HCPCS code in the space below. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. Plus, you may qualify for financial help to lower your health coverage costs. Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. 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. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). In Maine: Anthem Health Plans of Maine, Inc. Inpatient services and non-participating providers always require prior authorization. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. It looks like you're in . Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. You can also visit bcbs.com to find resources for other states. These documents are available to you as a reference when interpreting claim decisions. Select Auth/Referral Inquiry or Authorizations. We update the Code List to conform to the most recent publications of CPT and HCPCS . This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Please Select Your State The resources on this page are specific to your state. Choose your location to get started. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. The purpose of this communication is the solicitation of insurance. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. You can access the Precertification Lookup Tool through the Availity Portal. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. The resources for our providers may differ between states. Call our Customer Service number, (TTY: 711). Youll also strengthen your appeals with access to quarterly versions since 2011. Prior authorizations are required for: All non-par providers. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. We look forward to working with you to provide quality service for our members. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. We currently don't offer resources in your area, but you can select an option below to see information for that state. Find out if a service needs prior authorization. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Members should contact their local customer service representative for specific coverage information. Access to the information does not require an Availity role assignment, tax ID or NPI. It may not display this or other websites correctly. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. Reimbursement Policies. We offer affordable health, dental, and vision coverage to fit your budget. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. It looks like you're outside the United States. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Our call to Anthem resulted in a general statement basically use a different code. If you are unsure or have any questions, please be sure to check member eligibility and benefit coverage before proceeding with any authorization requests or services by contacting Provider Services at 800-901-0020. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Connecticut: Anthem Health Plans, Inc. Our resources vary by state. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Inpatient services and non-participating providers always require prior authorization. If you arent registered to use Availity, signing up is easy and 100% secure. Taking time for routine mammograms is an important part of staying healthy. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Other ways to access: If you are currently accessing the Pre-certification / Pre-Authorization Requirements list through your health plans public website, this option is still available for you. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. You are using an out of date browser. In Maine: Anthem Health Plans of Maine, Inc. Compare plans available in your area and apply today. We look forward to working with you to provide quality services to our members. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. We look forward to working with you to provide quality service for our members. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. You can also visit. Medicaid renewals will start again soon. Review medical and pharmacy benefits for up to three years. Current Procedural Terminology, more commonly known as CPT, refers to a medical code set created and maintained by the American Medical Association and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) We currently don't offer resources in your area, but you can select an option below to see information for that state. Select a State Policies & Guidelines Medical Policies & Clinical UM Guidelines There are several factors that impact whether a service or procedure is covered under a member's benefit plan. This tool is for outpatient services only. No provider of outpatient services gets paid without reporting the proper CPT codes. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. Your browser is not supported. New member? Use of the Anthem websites constitutes your agreement with our Terms of Use. This tool is for outpatient services only. In Indiana: Anthem Insurance Companies, Inc. We offer flexible group insurance plans for any size business. Lets make healthy happen. 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. Jan 1, 2020 Here you'll find information on the available plans and their benefits. If your state isn't listed, check out bcbs.com to find coverage in your area. You must log in or register to reply here. The MCG guidelines we are licensed to use include ((1) Inpatient & Surgical Care (ISC), (2) General Recovery Care (GRG), (3) Recovery Facility Care (RFC), (4) Chronic Care (CC) and (5) Behavioral Health Care Guidelines (BHG). We look forward to working with you to provide quality services to our members. The resources on this page are specific to your state. There is no cost for our providers to register or to use any of the digital applications. Members should contact their local customer service representative for specific coverage information. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. In Ohio: Community Insurance Company. March 2023 Anthem Provider News - Missouri, 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, April 2022 Anthem Provider News - Missouri, enable member benefit lookup by CPT and HCPC procedure codes, Enter up to eight procedure codes per transaction, provide additional cost share information by place of service, return Is Authorization Required? information, include additional plan-level benefit limitations.
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