These documents contain information about your benefits, network and coverage. Effective 01/01/2023 (includes changes effective 04/01/2023) . 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. Start by choosing your patient's network listed below. Do not sell or share my personal information. 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. BCBS FEP Vision covers frames, lenses, and eye exams. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. 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. Please refer to the criteria listed below for genetic testing. Long-Term Care (LTC) Forms. Please check your schedule of benefits for coverage information. Use of the Anthem websites constitutes your agreement with our Terms of Use. Forms and information to help you request prior authorization or file an appeal. Decide on what kind of signature to create. 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. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). In Kentucky: Anthem Health Plans of Kentucky, Inc. In the event of an emergency, members may access emergency services 24/7. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. Independent licensees of the Blue Cross Association. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. 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. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Electronic authorizations. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. 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. 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. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Look up common health coverage and medical terms. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. CareFirst Commercial Pre-Service Review and Prior Authorization. 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. In Connecticut: Anthem Health Plans, Inc. 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. 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 Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. 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 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. The latest edition and archives of our monthly provider newsletter. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Call our Customer Service number, (TTY: 711). Prior Authorization Requirements. Anthem offers great healthcare options for federal employees and their families. Select Patient Registration from the top navigation. This list contains notification/prior authorization requirements for inpatient and outpatient services. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. 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. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. This approval process is called prior authorization. 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. Prior Authorization. Code pairs reported here are updated quarterly based on the following schedule. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. Please verify benefit coverage prior to rendering services. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. endstream
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<. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Independent licensees of the Blue Cross and Blue Shield Association. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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 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). Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. 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. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. Commercial. 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. Access the BH Provider Manuals, Rates and Resources webpage here. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Forms and information about behavioral health services for your patients. 0
In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Pharmacy Forms. Anthem offers great healthcare options for federal employees and their families. Scroll down to the table of contents. One option is Adobe Reader which has a built-in reader. Information about benefits for your patients covered by the BlueCard program. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. Please check your schedule of benefits for coverage information. Prior authorization list. Inpatient services and nonparticipating providers always require prior authorization. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 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. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. (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.). Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. In Connecticut: Anthem Health Plans, Inc. 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. Medical Injectable Drugs: 833-581-1861. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 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. Contact 866-773-2884 for authorization regarding treatment. Information to help you maximize your performance in our quality programs. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). You'll also find news and updates for all lines of business. 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 Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. hbbd```b``+d3d]
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In Maine: Anthem Health Plans of Maine, Inc. 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. 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. Get the latest news to help improve your life and keep you healthy. Here you'll find information on the available plans and their benefits. Bundling Rationale (Claims filed before Aug. 25, 2017). 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. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. To learn more about required Colorado timelines for decisions regarding PA requests, please click, The Colorado Prescription Drug Prior Authorization Request form, The New Hampshire Prescription Drug Uniform Prior Authorization Request Form. 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. Forms and information about behavioral health services for your patients. 451 0 obj
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Drug list/Formulary inclusion does not infer a drug is a covered benefit. Inpatient Clinical: 800-416-9195. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Medicare Advantage. We encourage providers to use PPO outpatient services do not require Pre-Service Review. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Large Group Online - The AIM ProviderPortal is available 24x7. Referencing the . CareFirst Medicare Advantage requires notification/prior authorization of certain services. %%EOF
As your health needs evolve, our diverse plans are designed to evolve with you. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Type at least three letters and well start finding suggestions for you. 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. 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. Nov 1, 2021 Future updates regarding COVID-19 will appear in the monthly Provider News publication. Updated June 02, 2022. State & Federal / Medicare. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. 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