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 Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Please verify benefit coverage prior to rendering services. In Indiana: Anthem Insurance Companies, Inc. In 2020, Part B step therapy may apply to some categories . Please verify benefit coverage prior to rendering services. In Kentucky: Anthem Health Plans of Kentucky, Inc. Online - The AIM ProviderPortal is available 24x7. 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 requirements are specific to each patients policy type and the procedure(s) being rendered. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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 . 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. 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. To get started, select the state you live in. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. The Blue Cross name and symbol are registered marks of the Blue Cross Association. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Please check your schedule of benefits for coverage information. Type at least three letters and well start finding suggestions for you. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. External link You are leaving this website/app (site). In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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). 711. To view this file, you may need to install a PDF reader program. Create your signature and click Ok. Press Done. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 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. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. We look forward to working with you to provide quality services to our members. You may also view the prior approval information in the Service Benefit Plan Brochures. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. 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. Contact 866-773-2884 for authorization regarding treatment. Prior authorization list. (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. Inpatient Clinical: 800-416-9195. 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. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. endstream endobj 452 0 obj <. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Or Availity provides administrative services to BCBSIL. Medicare Advantage. Select Patient Registration from the top navigation. Providers should call the prior authorization number on the back of the member ID card. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Administrative. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. We look forward to working with you to provide quality service for our members. You'll also find news and updates for all lines of business. 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. 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. It clarifies a utilization management vendor change for specific members. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. 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 Independent licensees of the Blue Cross and Blue Shield Association. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Providers should continue to verify member eligibility and benefits prior to rendering services. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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 Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. 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. In Maine: Anthem Health Plans of Maine, Inc. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Electronic authorizations. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. In the event of an emergency, members may access emergency services 24/7. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. 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. 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. State & Federal / Medicare. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). You can also refer to the provider manual for information about services that require prior authorization. Please refer to the criteria listed below for genetic testing. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. 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. Referencing the . Medical Clearance Forms and Certifications of Medical Necessity. Future updates regarding COVID-19 will appear in the monthly Provider News publication. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. For your convenience, we've put these commonly used documents together in one place. For your convenience, we've put these commonly used documents together in one place. Use of the Anthem websites constitutes your agreement with our Terms of Use. Fax medical prior authorization request forms to: 844-864-7853 Code pairs reported here are updated quarterly based on the following schedule. Anthem offers great healthcare options for federal employees and their families. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Providers are responsible for verifying prior authorization requirements before services are rendered. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. 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. Long-Term Care (LTC) Forms. rationale behind certain code pairs in the database. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). In Ohio: Community Insurance Company. This approval process is called prior authorization. The clinical editing rationale supporting this database is provided here to assist you in understanding the ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Inpatient services and nonparticipating providers always require prior authorization. If you have any questions, call the number on the members ID card. May need to install a PDF reader program when it comes to prior authorization to check member and! To some categories Anthem offers great healthcare options for federal employees and their families admission. 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