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. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. 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. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. 494 0 obj <>stream Please use the 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. Mar 1, 2022 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. Type at least three letters and well start finding suggestions for you. Use of the Anthem websites constitutes your agreement with our Terms of Use. In the event of an emergency, members may access emergency services 24/7. 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 Start by choosing your patient's network listed below. We look forward to working with you to provide quality services to our members. To get started, select the state you live in. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. Anthem does not require prior authorization for treatment of emergency medical conditions. 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. Referencing the . In Kentucky: Anthem Health Plans of Kentucky, Inc. In Connecticut: Anthem Health Plans, Inc. These documents contain information about your benefits, network and coverage. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Get the latest news to help improve your life and keep you healthy. 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). 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. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Medicare Advantage. 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 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. This approval process is called prior authorization. Here you'll find information on the available plans and their benefits. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Nov 1, 2021 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. Medical Injectable Drugs: 833-581-1861. Fax medical prior authorization request forms to: 844-864-7853 Please check your schedule of benefits for coverage information. Contact 866-773-2884 for authorization regarding treatment. Details about new programs and changes to our procedures and guidelines. Provider Enrollment Forms. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. Some procedures may also receive instant approval. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. With three rich options to choose from, weve got you covered. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Start by choosing your patient's network listed below. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q Information to help you maximize your performance in our quality programs. . CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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. Please refer to the criteria listed below for genetic testing. 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. Commercial Prior Authorization Summary and Code Lists Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). For your convenience, we've put these commonly used documents together in one place. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Forms and information to help you request prior authorization or file an appeal. Anthem offers great healthcare options for federal employees and their families. Please Select Your State The resources on this page are specific to your state. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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). Decide on what kind of signature to create. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. The purpose of this communication is the solicitation of insurance. BCBS FEP Vision covers frames, lenses, and eye exams. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L Musculoskeletal (eviCore): 800-540-2406. There are three variants; a typed, drawn or uploaded signature. 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. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. endstream endobj startxref You can also refer to the provider manual for information about services that require prior authorization. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Forms and information about pharmacy services and prescriptions for your patients. Look up common health coverage and medical terms. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. You may also view the prior approval information in the Service Benefit Plan Brochures. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Or Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. Type at least three letters and well start finding suggestions for you. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 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. CoverKids. 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. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. For costs and complete details of the coverage, please contact your agent or the health plan. 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. 711. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Choose My Signature. Inpatient Clinical: 800-416-9195. Call our Customer Service number, (TTY: 711). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. 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. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. The site may also contain non-Medicare related information. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. This list contains notification/prior authorization requirements for inpatient and outpatient services. 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 . Forms and information about behavioral health services for your patients. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. In Maine: Anthem Health Plans of Maine, Inc. Online - The AIM ProviderPortal is available 24x7. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Large Group 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. If you have any questions, call the number on the members ID card. Independent licensees of the Blue Cross Association. 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 On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). Contact 866-773-2884 for authorization regarding treatment. Prior authorization list. This step will help you determine if prior authorization may be required for a specific member and service. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Create your signature and click Ok. Press Done. The prior authorization information in this notice does not apply to requests for HMO members. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Medical Clearance Forms and Certifications of Medical Necessity. 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. You'll also find news and updates for all lines of business. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. These documents contain information about upcoming code edits. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Drug list/Formulary inclusion does not infer a drug is a covered benefit. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Inpatient services and nonparticipating providers always require prior authorization. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. In Ohio: Community Insurance Company. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. Bundling Rationale (Claims filed before Aug. 25, 2017). One option is Adobe Reader which has a built-in reader. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. 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 Sign up to receive personalized communication from us, and active duty family members pharmacy prior authorization list has updated. The prior approval information in anthem prior authorization list 2022 event of an emergency, members may access emergency 24/7! Documents contain information about services that require prior authorization requirements and coverage may vary standard. Authorization or file an appeal provide quality services to our procedures and guidelines you speak any language than... 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