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. 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. Some procedures may also receive instant approval. An Independent Licensee of the Blue Cross and Blue Shield Association, Summary of Benefits & Coverage Information, Sleep Testing and Therapy & Advanced Imaging, Confirm your specific treatment plan and medical necessity given your diagnosis, Determine if services are eligible for coverage, Assure your claims are processed accurately and timely, Save you from unnecessary medical expenses. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). We also want to ensure you receive the right technology that addresses your particular clinical issue. Expand All We currently don't offer resources in your area, but you can select an option below to see information for that state. benefit certificate to determine which services need prior approval. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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 In Ohio: Community Insurance Company. In Indiana: Anthem Insurance Companies, Inc. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Prior authorization suspension for Anthem Ohio in-network hospital transfers to in-network skilled nursing facilities effective December 20, 2022 to January 15, 2023: Prior authorization suspension - In-network hospital transfers to In-network SNFs . Administrative. Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL Looks like you're using an old browser. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. 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, Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 2022 Electronic Forms LLC. Independent licensees of the Blue Cross and Blue Shield Association. Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. Precertification Lookup Tool -- easy access to prior authorization 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. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. 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. 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. View medication policies and pre-authorization requirements. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Sign in to the appropriate website to complete your request. 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). Polski | 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. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Step 9 At the top of page 2, provide the patients name and ID number. may be offered to you through such other websites or by the owner or operator of such other websites. The resources for our providers may differ between states. Online - The AIM ProviderPortal is available 24x7. In Maine: Anthem Health Plans of Maine, Inc. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. Get Started Prior-Authorization And Pre-Authorization | Anthem.com A new prior Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members Visit Anthem.com to learn more about how we coordinate our medical and pharmacy benefits, review our drug lists, submit prior authorization requests, and more. 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. Anthem partners with health care professionals to close gaps in care and improve members overall heath. Check whether a prior authorization is needed Check the status of a prior authorization This information is also available in other ways to people with disabilities by calling customer service at (651) 662-8000 (voice), or 1-800-382-2000 (toll free). 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. Anthem (Blue Cross Blue Shield) Prior (Rx) Authorization Form Prior Authorization Medication management With input from community physicians, specialty societies, and our Pharmacy & Therapeutics Committee, which includes community physicians and pharmacists from across the state, we design programs to help keep prescription drug coverage affordable. 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. Future updates regarding COVID-19 will appear in the monthly Provider News publication. 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. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. Contact CVS Caremark by phone at 844-345-3241 or visit their website. Portugus | Prior Authorization Requirement Summaries, Code Lists and - BCBSIL Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. You can also refer to the provider manual for information about services that require prior authorization. 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. Your plan has a list of services that require prior authorization. Use Availity to submit prior authorizations and check codes. This form should only be used for Arkansas Blue Cross and Blue Shield members. You can also visit bcbs.com to find resources for other states. Step 4 In Prescriber Information, specifythe prescribers full name, speciality, and full address. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. website and are no longer accessing or using any ABCBS Data. State & Federal / Medicare. 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). | In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. Updated June 02, 2022. 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. FEP utilizes Magellan Rx Management for medical, Providers requesting prior approval for an ASE/PSE member should use the appropriate form on the, Providers who are requesting a prior approval for Walmart or other BlueAdvantage members should use the appropriate form from the, Providers who are requesting a prior approval for BlueMedicare or Health Advantage Medicare Advantage members should use the appropriate form from, Providers requesting prior approval for Part B drugs for BlueMedicare or Health Advantage Medicare should use the, Name and telephone number of contact person, Requesting / Performing Providers NPI or Provider ID, Copy of members insurance card (front/back), CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable, Please use the most descriptive procedure and diagnosis codes, Medical records to support requested services. Blueprint Portal is a members-only website that will help you understand and manage your health plan so youre able to find quality, patient-focused healthcare at the best possible price. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. There is a list of these services in your member contract. federal and Washington state civil rights laws. 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. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Prior authorization lookup tool | NY Provider - Empire Blue Cross The formcontains important information regarding the patients medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patients health care plan. under any circumstances for the activities, omissions or conduct of any owner or operator of any other In the case of a medical emergency, you do not need prior authorization to receive care. color, national origin, age, disability, sex, gender identity, or sexual orientation. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Information about COVID-19 and your insurance coverage. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. . You understand and agree that by making any State & Federal / Medicare. 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. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). Pharmacy Information for Providers | Anthem.com - Empire Blue 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. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. If you receive services that are not medically necessary from one of Blue Cross of Idahos contracting providers without getting prior authorization and payment for the services is denied, you are not financially responsible. The best way to ensure you're submitting everything needed for a prior authorization is to use the prior authorization/precertification form at anthem.com/medicareprovider > Providers > Provider Resources > Forms and Guides. | It looks like you're outside the United States. Sep 1, 2021 Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible 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. . Espaol | Federal Employee Program. In Ohio: Community Insurance Company. We look forward to working with you to provide quality service for our members. Prior authorization/precertification form notification - Anthem Find a Care Center. | This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. If you're concerned about losing coverage, we can connect you to the right options for you and your family. We look forward to working with you to provide quality services to our members. You can access the Precertification Lookup Tool through the Availity Portal. third-party website link available as an option to you, ABCBS does not in any way endorse any such website, 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. Review requirements for Medicare Advantage members. 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. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). | In the event of an emergency, members may access emergency services 24/7. 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. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. 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 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. Our resources vary by state. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. You are invited: Advancing Mental Health Equity for Youth & Young Adults. Noncompliance with new requirements may result in denied claims. Some procedures may also receive instant approval. Find care, claims & more with our new app. 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. If you choose to access other websites from this website, you agree, as a condition of choosing any such | FEP Basic Option/Standard OptionFEP Blue Focus. P | Prior Authorization Requirements - Blue Cross MN You can find the number on the back of your ID card, or you can write to us at the following address: Appeals and Grievance CoordinatorBlue Cross of IdahoPO Box 7408Boise, ID 83707. We currently don't offer resources in your area, but you can select an option below to see information for that state. link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to 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. Pre-Cert/Pre-Auth (In-Network) - CareFirst In Ohio: Community Insurance Company. This tool is for outpatient services only. Prior authorization lookup tool | KY Provider - Anthem CareMore Health Home | CareMore Health Your dashboard may experience future loading problems if not resolved. In Indiana: Anthem Insurance Companies, Inc. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. Independent licensees of the Blue Cross Association. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). Type at least three letters and we will start finding suggestions for you. In some cases, we require more information and will request additional records so we can make a fully informed decision. In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. | You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Prior authorization list | Blue Shield of CA Provider 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. Type at least three letters and well start finding suggestions for you. Prior Authorization Requirements | NY Provider - Empire Blue Cross The resources for our providers may differ between states. Italiano | 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.
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