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.). 2022 Standard Pre-certification list . ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. To view this file, you may need to install a PDF reader program. Choose My Signature. CareFirst reserves the right to change this list at any time without notice. This approval process is called prior authorization. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use. Medical Clearance Forms and Certifications of Medical Necessity. These documents contain information about upcoming code edits. 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. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Musculoskeletal (eviCore): 800-540-2406. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . Expedited fax: 888-235-8390. Updated June 02, 2022. Please refer to the criteria listed below for genetic testing. Noncompliance with new requirements may result in denied claims. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Medicare Advantage. In Maine: Anthem Health Plans of Maine, Inc. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. With three rich options to choose from, weve got you covered. 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). 451 0 obj
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Not connected with or endorsed by the U.S. Government or the federal Medicare program. We look forward to working with you to provide quality services to our members. 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. 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. You can also check status of an existing request and auto-authorize more than 40 common procedures. 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. Online - The AIM ProviderPortal is available 24x7. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Long-Term Care (LTC) Forms. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Scroll down to the table of contents. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). endstream
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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. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Inpatient services and nonparticipating providers always require prior authorization. Do not sell or share my personal information. To get started, select the state you live in. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. In Indiana: Anthem Insurance Companies, Inc. 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. Providers are responsible for verifying prior authorization requirements before services are rendered. 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. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. In Connecticut: Anthem Health Plans, Inc. Prior Authorization Requirements. (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. Electronic authorizations. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. 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. Information to help you maximize your performance in our quality programs. 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. Third-Party Liability (TPL) Forms. 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. Or PPO outpatient services do not require Pre-Service Review. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. Please check your schedule of benefits for coverage information. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. In addition, some sites may require you to agree to their terms of use and privacy policy. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Please verify benefit coverage prior to rendering services. Nov 1, 2021 Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. The site may also contain non-Medicare related information. 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). Anthem is a registered trademark of Anthem Insurance Companies, Inc. This approval process is called prior authorization. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. 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. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. CareFirst Commercial Pre-Service Review and Prior Authorization. 494 0 obj
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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). Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. 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. In Kentucky: Anthem Health Plans of Kentucky, Inc. One option is Adobe Reader which has a built-in reader. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. 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. Type at least three letters and well start finding suggestions for you. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. ). Medicaid Behavioral/Physical Health Coordination. For costs and complete details of the coverage, please contact your agent or the health plan. 477 0 obj
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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. Start by choosing your patient's network listed below. The services marked with an asterisk (*) only require Pre-Service Review for members enrolled in BlueChoice products if performed in an outpatient setting that is on the campus of a hospital. 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 Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Decide on what kind of signature to create. Select Patient Registration from the top navigation. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). These manuals are your source for important information about our policies and procedures. Prior Authorization. Future updates regarding COVID-19 will appear in the monthly Provider News publication. AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. Inpatient services and nonparticipating providers always require prior authorization. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. Contact 866-773-2884 for authorization regarding treatment. 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 Start by choosing your patient's network listed below. Anthem offers great healthcare options for federal employees and their families. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. In Kentucky: Anthem Health Plans of Kentucky, Inc. Independent licensees of the Blue Cross Association. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . In Connecticut: Anthem Health Plans, Inc. There are three variants; a typed, drawn or uploaded signature. 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. Inpatient Clinical: 800-416-9195. 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 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. 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. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. This tool is for outpatient services only. 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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. 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. You can also refer to the provider manual for information about services that require prior authorization. Please use the These documents contain information about your benefits, network and coverage. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Bundling Rationale (Claims filed before Aug. 25, 2017). On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. External link You are leaving this website/app (site).
Independent licensees of the Blue Cross and Blue Shield Association. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. hb``` ce`a`Y5
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PPO outpatient services do not require Pre-Service Review. 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 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. For your convenience, we've put these commonly used documents together in one place. The clinical editing rationale supporting this database is provided here to assist you in understanding the 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. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Contact will be made by an insurance agent or insurance company. Provider Enrollment Forms. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. 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 As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. CareFirst Medicare Advantage requires notification/prior authorization of certain services. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Some procedures may also receive instant approval. Forms and information about behavioral health services for your patients. Providers should continue to verify member eligibility and benefits prior to rendering services. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Do not sell or share my personal information. Medical Injectable Drugs: 833-581-1861. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Mar 1, 2022 CoverKids. The latest edition and archives of our quarterly quality newsletter. BlueCross BlueShield of Tennessee uses a clinical editing database. As your health needs evolve, our diverse plans are designed to evolve with you. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. 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. 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. If you have any questions, call the number on the members ID card. To get started, select the state you live in. Forms and information to help you request prior authorization or file an appeal. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. 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. 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 Please check your schedule of benefits for coverage information. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Select Auth/Referral Inquiry or Authorizations. In Ohio: Community Insurance Company. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Administrative. 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. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Details about new programs and changes to our procedures and guidelines. 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 %PDF-1.6
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