Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Scroll down to the table of contents. 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). U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. Most PDF readers are a free download. Independent licensees of the Blue Cross and Blue Shield Association. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. 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. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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. Get the latest news to help improve your life and keep you healthy. Inpatient services and nonparticipating providers always require prior authorization. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Access the BH Provider Manuals, Rates and Resources webpage here. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. 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. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Select Auth/Referral Inquiry or Authorizations. Anthem does not require prior authorization for treatment of emergency medical conditions. CareFirst reserves the right to change this list at any time without notice. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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. 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. Type at least three letters and well start finding suggestions for you. Contact will be made by an insurance agent or insurance company. The latest edition and archives of our quarterly quality newsletter. 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. 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. Providers should call the prior authorization number on the back of the member ID card. Code pairs reported here are updated quarterly based on the following schedule. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. For costs and complete details of the coverage, please contact your agent or the health plan. In Connecticut: Anthem Health Plans, Inc. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. Information about benefits for your patients covered by the BlueCard program. PPO outpatient services do not require Pre-Service Review. %%EOF 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. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. CareFirst Commercial Pre-Service Review and Prior Authorization. Future updates regarding COVID-19 will appear in the monthly Provider News publication. 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. Information to help you maximize your performance in our quality programs. 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. Choose My Signature. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. CoverKids. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Inpatient Clinical: 800-416-9195. Third-Party Liability (TPL) Forms. Independent licensees of the Blue Cross Association. It clarifies a utilization management vendor change for specific members. 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 (Nonpharmacy) Provider Correspondence Forms. Call our Customer Service number, (TTY: 711). Forms and information about behavioral health services for your patients. Bundling Rationale (Claims filed before Aug. 25, 2017). In Kentucky: Anthem Health Plans of Kentucky, Inc. Prior Authorization. If you have any questions, call the number on the members ID card. 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. We encourage providers to use One option is Adobe Reader which has a built-in reader. Nov 1, 2021 eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. 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. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Noncompliance with new requirements may result in denied claims. 451 0 obj <> endobj Availity provides administrative services to BCBSIL. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans 494 0 obj <>stream BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. This new site may be offered by a vendor or an independent third party. In addition, some sites may require you to agree to their terms of use and privacy policy. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. 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. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. 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. To view this file, you may need to install a PDF reader program. 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. Forms and information to help you request prior authorization or file an appeal. endstream endobj 452 0 obj <. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Use of the Anthem websites constitutes your agreement with our Terms of Use. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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. 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 list may vary based on account contracts and should be verified by contacting 1-866-773-2884. 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. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Please verify benefit coverage prior to rendering services. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. This approval process is called prior authorization. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Please use the 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. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. In Indiana: Anthem Insurance Companies, Inc. External link You are leaving this website/app (site). Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Large Group ICR offers a fast, efficient way to securely submit your requests with clinical documentation. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. The latest edition and archives of our monthly provider newsletter. CareFirst does not guarantee that this list is complete or current. Electronic authorizations. 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. 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 ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. 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 check your schedule of benefits for coverage information. Mar 1, 2022 The purpose of this communication is the solicitation of insurance. In Indiana: Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. We look forward to working with you to provide quality services to our members. This step will help you determine if prior authorization may be required for a specific member and service. Details about new programs and changes to our procedures and guidelines. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Independent licensees of the Blue Cross Association. You'll also find news and updates for all lines of business. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. endstream endobj startxref 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). Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. These manuals are your source for important information about our policies and procedures. 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 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. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. The prior authorization information in this notice does not apply to requests for HMO members. 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