Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. website. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. of all such websites. under any circumstances for the activities, omissions or conduct of any owner or operator of any other Medical Policy and Prior Authorization for Blue Plans. | Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. Use Availity to submit prior authorizations and check codes. In some cases, we require more information and will request additional records so we can make a fully informed decision. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. We currently don't offer resources in your area, but you can select an option below to see information for that state. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. The resources for our providers may differ between states. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. 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. View the FEP-specific code list and forms. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Type at least three letters and well start finding suggestions for you. 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. Sep 1, 2021 By filling out the form completely and with as much information as possible, you can be sure we have the information to process your request timely. The CarelonRx member services telephone number is 833-279-0458. Step 5 In Medication / Medical and Dispensing Information, specify the medication name and indicate whether or not the request is a new therapy or a renewal (if renewal, specifythe date therapy started and the duration). Review requirements for Medicare Advantage members. This tool is for outpatient services only. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in New Hampshire. 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. Tagalog | Contact CVS Caremark by phone at 844-345-3241 or visit their website. View requirements for group and Individual members on our commercial products. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. third-party website link available as an option to you, ABCBS does not in any way endorse any such website, We deliver personalized healthcare the way you want it, where you need it: in our neighborhood Care Centers, in your own home, in hospitals or skilled nursing facilities. It looks like you're outside the United States. We look forward to working with you to provide quality services to our members. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. You are invited: Advancing Mental Health Equity for Youth & Young Adults. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Prior authorization is required for surgical services only. Inpatient services and nonparticipating providers always require prior authorization. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Independent licensees of the Blue Cross and Blue Shield Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. It looks like you're in . It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. In Maine: Anthem Health Plans of Maine, Inc. Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas. | March 2023 Anthem Provider News - New Hampshire, February 2023 Provider Newsletter - New Hampshire, Telephonic-only care allowance extended through April 11, 2023 - New Hampshire, January 2023 Provider Newsletter - New Hampshire, Reimbursement for services by clinical behavioral health providers seeking licensure, Time to prepare for HEDIS medical record review, New policy for EMR clinical data sharing and ADT notifications, Reimbursement policy update: Modifiers 25 and 57 - Professional, Specialty pharmacy updates for March 2023, Clinical Criteria updates for specialty pharmacy. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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., 2023. On January 1, 2021, Anthem Blue Cross and Blue Shield prior authorization (PA) requirements will change for codes below. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. If you choose to access other websites from this website, you agree, as a condition of choosing any such Step 9 At the top of page 2, provide the patients name and ID number. | Posted Jan. 11, 2021. Federal Employee Program. With prior authorization, Blue Cross of Idaho is able to: Prior authorization is just one of the ways we're working to save our members money and address rising healthcare costs. February 2023 Anthem Provider News - Ohio, New ID cards for Anthem Blue Cross and Blue Shield members - Ohio, Telephonic-only care allowance extended through April 11, 2023 - Ohio, C1764 Event recorder, cardiac (implantable), E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized, E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, G0460 Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment, L3000 Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each, L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, L3170 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each, L3310 Lift, elevation, heel and sole, neoprene, per inch, L3332 Lift, elevation, inside shoe, tapered, up to one-half inch, L3580 Ortho shoe add instep Velcro closure, L3610 Transfer of an orthosis from one shoe to another, caliper plate, new, L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing, L3630 Transfer of an orthosis from one shoe to another, solid stirrup, new, L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified, L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf, L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf, L3761 Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf, L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf, L3807 Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise, L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type, L3912 Hand-finger orthosis (HFO), flexion glove with elastic finger control, prefabricated, off-the-shelf, L3913 HFO, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment, L3923 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. 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 Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. In Maine: Anthem Health Plans of Maine, Inc. State & Federal / Medicare. They may request or review medical records, test results and other information so they understand what services are being performed and are able to make an informed decision. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We also want to ensure you receive the right technology that addresses your particular clinical issue. Polski | The site may not work properly. In the event of an emergency, members may access emergency services 24/7. 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. March 2023 Anthem Provider News - Georgia, February 2023 Anthem Provider News - Georgia, New ID cards for Anthem Blue Cross and Blue Shield members - Georgia, Telephonic-only care allowance extended through April 11, 2023 - Georgia, January 2023 Anthem Provider News - Georgia, prior authorization/precertification form, September 2021 Anthem Provider News - Georgia. In Indiana: Anthem Insurance Companies, Inc. 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. Register today for the Advancing Mental Health Equity for Youth & Young Adults forum hosted by Anthem Blue Cross and Blue Shield (Anthem) and Motivo* for Anthem providers on March 15, 2023. Prior to surgical treatment of gender dysphoria in FEP members, you must submit a treatment plan, including all surgeries planned, and the estimated date each will be performed. Other Blue Plans pre-authorization requirements may differ from ours. Independent licensees of the Blue Cross and Blue Shield Association. 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. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Select Auth/Referral Inquiry or Authorizations. Kreyl Ayisyen | may be offered to you through such other websites or by the owner or operator of such other websites. Type at least three letters and we will start finding suggestions for you. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. Your plan has a list of services that require prior authorization. Inpatient services and nonparticipating providers always require prior authorization. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. In Indiana: Anthem Insurance Companies, Inc. Administrative. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Once you choose to link to another website, you understand and agree that you have exited this Please update your browser if the service fails to run our website. Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). Our resources vary by state. Anthem is a registered trademark of Anthem Insurance Companies, Inc. In Maine: Anthem Health Plans of Maine, Inc. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. The resources for our providers may differ between states. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, You can also visit bcbs.com to find resources for other states. Use the search tool to find the Care Center closest to you. Oct 1, 2020 Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. 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. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. 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. 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. Log into the Members portal to view the status of your prior authorization under the Claims &Eligibility menu. 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. . Your dashboard may experience future loading problems if not resolved. Independent licensees of the Blue Cross Association. We're here to work with you, your doctor and the facility so you have the best possible health outcome. Find a Care Center. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. No, the need for emergency services does not require prior authorization. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. 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. Some procedures may also receive instant approval. 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 Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Looks like you're using an old browser. In the case of a medical emergency, you do not need prior authorization to receive care. To stay covered, Medicaid members will need to take action. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services. Carelon Medical Benefits Management, Inc. You are invited: Advancing Mental Health Equity for Youth & Young Adults, Reminder: Updated Carelon Medical Benefits Management, Inc. Musculoskeletal Program effective April 1, 2023 - Site of care reviews, Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update, Provider directory - annual audit for NCQA Accreditation, Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures, March is National Colorectal Cancer Awareness Month, Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews, Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023, Pharmacy information available on our provider website, Controlling High Blood Pressure and Submitting Compliant Readings, Shared savings and transition care management after inpatient discharges. 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. o Massachusetts Collaborative Prior Authorization Form or o Blue Cross Blue Shield of Massachusetts Pre-certification Request Form Click on the title for complete list of drugs that require prior authorization: Medical Benefit Prior Authorization Medication List, #034 Medical Utilization Management and Pharmacy Prior Authorization, #033 In Connecticut: Anthem Health Plans, Inc. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Use of the Anthem websites constitutes your agreement with our Terms of Use. Select Auth/Referral Inquiry or Authorizations. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. Please refer to the criteria listed below for genetic testing. 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. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Non-individual members Use Availity to submit prior authorizations and check codes. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. Information about COVID-19 and your insurance coverage. Prior approval for requested services - Arkansas Blue Cross and Blue Shield Prior approval for requested services The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Sign in to the appropriate website to complete your request. URAC Accredited - Health Plan with Health Insurance Marketplace (HIM) - 7.3, URAC Accredited - Health Utilization Management - 7.4, Member forms - Individual and family plans, Coverage policy and pre-certification/pre-authorization, Approval information for radiological services, Medicare Advantage Prior Authorization Request Form, Part B Medication Prior Approval Request Form, Check deductible and out-of-pocket totals. State & Federal / Medicare. Please verify benefit coverage prior to rendering services. Franais | ), 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation, 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach, 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach, 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach, 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy), 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis, 33419 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure), 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed, 33979 Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle, 33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only, 36514 Therapeutic Apheresis; Plasma Pheresis, 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection, 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed, A4224 Supplies for maintenance of insulin infusion catheter, per week, A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each, A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe, A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fah, A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each, A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries, C1722 Cardioverter-defibrillator, single chamber (implantable), L5671 Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert, L5673 Addition to lower extremity, below knee/above knee, custom fabricated, L5679 Addition to lower extremity, below knee/above knee, custom fabricated, L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature, L5981 All lower extremity prostheses, flex-walk system or equal, L5987 All lower extremity prostheses, shank foot system with vertical loading pylon, L8699 Prosthetic implant, not otherwise specified, L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code. Use of the Anthem websites constitutes your agreement with our Terms of Use. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. More prior authorization resources Sign in to Availity Contact 866-773-2884 for authorization regarding treatment. You further agree that ABCBS and its Some procedures may also receive instant approval. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. You can also visit, Standard Local Prior Authorization Code List, Standard Prior Authorization Requirements, SHBP Precertification Procedure Codes Sheet, SHBP Co-pay/Co-insurance Waiver Medication List. Italiano | ABCBS makes no warranties or representations of any kind, express or implied, nor You understand and agree that by making any . Your browser is not supported. Step 1 At the top of the form, supply the plan/medical group name, plan/medical group phone number, and plan/medical group fax number. In Kentucky: Anthem Health Plans of Kentucky, Inc. Deutsch |