Providers are responsible for verifying prior authorization requirements before services are rendered. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. 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. Updated June 02, 2022. Start by choosing your patient's network listed below. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. For your convenience, we've put these commonly used documents together in one place. CareFirst Commercial Pre-Service Review and Prior Authorization. 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. 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. Prior Authorization. Expedited fax: 888-235-8390. 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. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. %%EOF
rationale behind certain code pairs in the database. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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). 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. Code pairs reported here are updated quarterly based on the following schedule. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . Long-Term Care (LTC) Forms. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. These documents contain information about your benefits, network and coverage. 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. There are three variants; a typed, drawn or uploaded signature. Commercial Prior Authorization Summary and Code Lists 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. 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). Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. 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. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. We encourage providers to use The purpose of this communication is the solicitation of insurance. 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. Mar 1, 2022 Use of the Anthem websites constitutes your agreement with our Terms of Use. You'll also find news and updates for all lines of business. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member.
Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. In addition, some sites may require you to agree to their terms of use and privacy policy. One option is Adobe Reader which has a built-in reader. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. BlueCross BlueShield of Tennessee uses a clinical editing database. Providers should continue to verify member eligibility and benefits prior to rendering services. Administrative. Please refer to the criteria listed below for genetic testing. 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. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Most PDF readers are a free download. Forms and information about behavioral health services for your patients. For more information, please refer to the Medical Policy Reference Manual. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. These manuals are your source for important information about our policies and procedures. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . In Connecticut: Anthem Health Plans, Inc. Anthem offers great healthcare options for federal employees and their families. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Contact will be made by an insurance agent or insurance company. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Prior authorization list. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Please use the 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. Effective 01/01/2023 (includes changes effective 04/01/2023) . A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. To view this file, you may need to install a PDF reader program. 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. 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. Musculoskeletal (eviCore): 800-540-2406. This list contains notification/prior authorization requirements for inpatient and outpatient services. . This tool is for outpatient services only. Please check your schedule of benefits for coverage information. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Providers should call the prior authorization number on the back of the member ID card. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Access the BH Provider Manuals, Rates and Resources webpage here. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. In Connecticut: Anthem Health Plans, Inc. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. 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. Fax medical prior authorization request forms to: 844-864-7853
Independent licensees of the Blue Cross and Blue Shield Association. Availity provides administrative services to BCBSIL. 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. Large Group BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. endstream
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Please verify benefit coverage prior to rendering services. Get the latest news to help improve your life and keep you healthy. 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 requirements will be added for the following codes: Not all PA requirements are listed here. CoverKids. Forms and information about pharmacy services and prescriptions for your patients. endstream
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<. Medicare Advantage. Medical Injectable Drugs: 833-581-1861. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. The latest edition and archives of our monthly provider newsletter. 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. 494 0 obj
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Here you'll find information on the available plans and their benefits. Independent licensees of the Blue Cross and Blue Shield Association. We look forward to working with you to provide quality services to our members. Anthem does not require prior authorization for treatment of emergency medical conditions. 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. Bundling Rationale (Claims filed before Aug. 25, 2017). The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Type at least three letters and well start finding suggestions for you. (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.). Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Do not sell or share my personal information. Drug list/Formulary inclusion does not infer a drug is a covered benefit. 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. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. We look forward to working with you to provide quality services to our members. Referencing the . This approval process is called prior authorization. ). 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