Please refer to the criteria listed below for genetic testing. Prior Authorization Requirements. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Independent licensees of the Blue Cross and Blue Shield Association. Type at least three letters and well start finding suggestions for you. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. Musculoskeletal (eviCore): 800-540-2406. rationale behind certain code pairs in the database. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. State & Federal / Medicare. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. 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. 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. BlueCross BlueShield of Tennessee uses a clinical editing database. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. This approval process is called prior authorization. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. Providers should call the prior authorization number on the back of the member ID card. 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. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Here you'll find information on the available plans and their benefits. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. 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). In the event of an emergency, members may access emergency services 24/7. For your convenience, we've put these commonly used documents together in one place. Forms and information about behavioral health services for your patients. Independent licensees of the Blue Cross and Blue Shield Association. 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 offers great healthcare options for federal employees and their families. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. Select Auth/Referral Inquiry or Authorizations. Forms and information to help you request prior authorization or file an appeal. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. 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. BCBS FEP Vision covers frames, lenses, and eye exams. Here youll find information on the available plans and their benefits. Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. For your convenience, we've put these commonly used documents together in one place. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Mar 1, 2022 To get started, select the state you live in. Administrative. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Access the BH Provider Manuals, Rates and Resources webpage here. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Contact will be made by an insurance agent or insurance company. (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. Get the latest news to help improve your life and keep you healthy. Anthem offers great healthcare options for federal employees and their families. The site may also contain non-Medicare related information. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . 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). Or 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. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. 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. Please verify benefit coverage prior to rendering services. Please check your schedule of benefits for coverage information. These manuals are your source for important information about our policies and procedures. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. In Kentucky: Anthem Health Plans of Kentucky, Inc. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. You'll also find news and updates for all lines of business. 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. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. Forms and information about pharmacy services and prescriptions for your patients. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. In Connecticut: Anthem Health Plans, Inc. PPO outpatient services do not require Pre-Service Review. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Medicare Advantage. You can also check status of an existing request and auto-authorize more than 40 common procedures. We also support our providers with access to information about our plans and member benefits, news and updates, training materials and guides and other helpful resources. Do not sell or share my personal information. This new site may be offered by a vendor or an independent third party. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. Third-Party Liability (TPL) Forms. 494 0 obj <>stream Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Online - The AIM ProviderPortal is available 24x7. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Pharmacy Forms. Noncompliance with new requirements may result in denied claims. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 0 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. We look forward to working with you to provide quality services to our members. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. For more information, please refer to the Medical Policy Reference Manual. Start by choosing your patient's network listed below. 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. To view this file, you may need to install a PDF reader program. 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). 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. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. 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. Provider Enrollment Forms. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Create your signature and click Ok. Press Done. Medicaid Behavioral/Physical Health Coordination. 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 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. Start by choosing your patient's network listed below. 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 Independent licensees of the Blue Cross Association. Long-Term Care (LTC) Forms. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Do not sell or share my personal information. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Please refer to the criteria listed below for genetic testing. 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. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . 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 The clinical editing rationale supporting this database is provided here to assist you in understanding the 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. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists In addition, some sites may require you to agree to their terms of use and privacy policy. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. 2022 Standard Pre-certification list . ). Fax medical prior authorization request forms to: 844-864-7853 These documents contain information about upcoming code edits. 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. 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. 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