Independent licensees of the Blue Cross Association. Online - The AIM ProviderPortal is available 24x7. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Anthem offers great healthcare options for federal employees and their families. 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). Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Create your signature and click Ok. Press Done. PPO outpatient services do not require Pre-Service Review. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 0 Most PDF readers are a free download. The Blue Cross name and symbol are registered marks of the Blue Cross Association. The prior authorization information in this notice does not apply to requests for HMO members. Anthem does not require prior authorization for treatment of emergency medical conditions. Start by choosing your patient's network listed below. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. 2022 Standard Pre-certification list . In Kentucky: Anthem Health Plans of Kentucky, Inc. Select Auth/Referral Inquiry or Authorizations. 451 0 obj <> endobj In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. This approval process is called prior authorization. Contact 866-773-2884 for authorization regarding treatment. We look forward to working with you to provide quality services to our members. Prior Authorization. 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. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. 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 Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Information to help you maximize your performance in our quality programs. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. Inpatient Clinical: 800-416-9195. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. One option is Adobe Reader which has a built-in reader. Forms and information to help you request prior authorization or file an appeal. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Commercial Prior Authorization Summary and Code Lists 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. 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. This list contains notification/prior authorization requirements for inpatient and outpatient services. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. In Indiana: Anthem Insurance Companies, Inc. The latest edition and archives of our monthly provider newsletter. Prior authorization list. In Maine: Anthem Health Plans of Maine, Inc. 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. As your health needs evolve, our diverse plans are designed to evolve with you. ). An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. In Connecticut: Anthem Health Plans, Inc. Pharmacy Forms. Please verify benefit coverage prior to rendering services. 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 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. To view this file, you may need to install a PDF reader program. Choose My Signature. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. 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 Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Medical Injectable Drugs: 833-581-1861. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. These manuals are your source for important information about our policies and procedures. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Forms and information about pharmacy services and prescriptions for your patients. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) Availity provides administrative services to BCBSIL. 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Learn about the NAIC rules regarding coordination of benefits. To get started, select the state you live in. 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. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. 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. 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 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. Inpatient services and nonparticipating providers always require prior authorization. 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. 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.). The clinical editing rationale supporting this database is provided here to assist you in understanding the The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Use of the Anthem websites constitutes your agreement with our Terms of Use. Details about new programs and changes to our procedures and guidelines. 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 Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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. Administrative. These documents contain information about your benefits, network and coverage. Here you'll find information on the available plans and their benefits. Rx Prior Authorization. 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 We encourage providers to use 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. 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. With three rich options to choose from, weve got you covered. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. Contact 866-773-2884 for authorization regarding treatment. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Please refer to the criteria listed below for genetic testing. Please check your schedule of benefits for coverage information. Look up common health coverage and medical terms. 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Drug list/Formulary inclusion does not infer a drug is a covered benefit. You may also view the prior approval information in the Service Benefit Plan Brochures. 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. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. You can also check status of an existing request and auto-authorize more than 40 common procedures. (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. In Maine: Anthem Health Plans of Maine, Inc. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Please Select Your State The resources on this page are specific to your state. BCBS FEP Vision covers frames, lenses, and eye exams. In addition, some sites may require you to agree to their terms of use and privacy policy. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. In Ohio: Community Insurance Company. 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. CoverKids. 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. Inpatient services and nonparticipating providers always require prior authorization. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. 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 ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Reader program in Georgia: Blue Cross name and symbol are registered marks of Blue! 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