ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Information to help you maximize your performance in our quality programs. Scroll down to the table of contents. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. 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). These documents contain information about upcoming code edits. Prior authorization list. Rx Prior Authorization. Referencing the . 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. Anthem offers great healthcare options for federal employees and their families. Forms and information about behavioral health services for your patients. Medical Clearance Forms and Certifications of Medical Necessity. The "Prior authorization list" is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. 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. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. Providers are responsible for verifying prior authorization requirements before services are rendered. 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. %%EOF Type at least three letters and well start finding suggestions for you. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 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). Provider Enrollment Forms. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. We look forward to working with you to provide quality services to our members. Use of the Anthem websites constitutes your agreement with our Terms of Use. Anthem offers great healthcare options for federal employees and their families. 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. Musculoskeletal (eviCore): 800-540-2406. 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. Prior Authorization Requirements. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). The latest edition and archives of our quarterly quality newsletter. The Blue Cross name and symbol are registered marks of the Blue Cross Association. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L Here you'll find information on the available plans and their benefits. 2022 Standard Pre-certification list . Anthem is a registered trademark of Anthem Insurance Companies, Inc. The purpose of this communication is the solicitation of insurance. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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. Get the latest news to help improve your life and keep you healthy. Electronic authorizations. 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. Fax medical prior authorization request forms to: 844-864-7853 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 Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Nov 1, 2021 Online - The AIM ProviderPortal is available 24x7. Information about benefits for your patients covered by the BlueCard program. In Indiana: Anthem Insurance Companies, Inc. 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 In 2020, Part B step therapy may apply to some categories . Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. 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). 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. Please refer to the criteria listed below for genetic testing. Please verify benefit coverage prior to rendering services. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. 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. Providers should continue to verify member eligibility and benefits prior to rendering services. 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. Providers should continue to verify member eligibility and benefits prior to rendering services. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. BCBS FEP Vision covers frames, lenses, and eye exams. Contact 866-773-2884 for authorization regarding treatment. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. This list contains notification/prior authorization requirements for inpatient and outpatient services. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. Forms and information to help you request prior authorization or file an appeal. One option is Adobe Reader which has a built-in reader. Please verify benefit coverage prior to rendering services. 494 0 obj <>stream Long-Term Care (LTC) Forms. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. 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. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Administrative. Start by choosing your patient's network listed below. Expedited fax: 888-235-8390. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Not connected with or endorsed by the U.S. Government or the federal Medicare program. 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 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. %PDF-1.6 % Please check your schedule of benefits for coverage information. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. endstream endobj startxref Please use the Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. Drug list/Formulary inclusion does not infer a drug is a covered benefit. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. These manuals are your source for important information about our policies and procedures. CareFirst Commercial Pre-Service Review and Prior Authorization. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. This new site may be offered by a vendor or an independent third party. Bundling Rationale (Claims filed before Aug. 25, 2017). To view this file, you may need to install a PDF reader program. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Providers should call the prior authorization number on the back of the member ID card. 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. 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. Effective 01/01/2023 (includes changes effective 04/01/2023) . In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensees of the Blue Cross and Blue Shield Association. 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. For your convenience, we've put these commonly used documents together in one place. Mar 1, 2022 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. 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. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Call our Customer Service number, (TTY: 711). 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. Start by choosing your patient's network listed below. 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. For more information, please refer to the Medical Policy Reference Manual. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. This tool is for outpatient services only. Please refer to the criteria listed below for genetic testing. CareFirst does not guarantee that this list is complete or current. Future updates regarding COVID-19 will appear in the monthly Provider News publication. With three rich options to choose from, weve got you covered. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. Large Group 0 In addition, some sites may require you to agree to their terms of use and privacy policy. In Kentucky: Anthem Health Plans of Kentucky, Inc. You'll also find news and updates for all lines of business. 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 Type at least three letters and well start finding suggestions for you. Third-Party Liability (TPL) Forms. We encourage providers to use Access the BH Provider Manuals, Rates and Resources webpage here. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. 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. 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. endstream endobj 452 0 obj <. Commercial. External link You are leaving this website/app (site). . Medical Injectable Drugs: 833-581-1861. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. In Maine: Anthem Health Plans of Maine, Inc. Updated June 02, 2022. Select Patient Registration from the top navigation. 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. Pharmacy Forms. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. In Ohio: Community Insurance Company. CareFirst reserves the right to change this list at any time without notice. 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. 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. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. 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. Or The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. 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. 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. 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 Choose My Signature. In Ohio: Community Insurance Company. As your health needs evolve, our diverse plans are designed to evolve with you. 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.). You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. Here youll find information on the available plans and their benefits. 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. 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