Fax the completed form to 1-844-429-7757 within one business day of the determination/action. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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. We look forward to working with you to provide quality services to our members. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Select Auth/Referral Inquiry or Authorizations. In Connecticut: Anthem Health Plans, Inc. Complete all member information fields on this form: Complete either the denial or the termination information section. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. Get Started Type at least three letters and well start finding suggestions for you. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. 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. Updated June 02, 2022. Select Auth/Referral Inquiry or Authorizations. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. You can also visit bcbs.com to find resources for other states. | Use of the Anthem websites constitutes your agreement with our Terms of Use. website. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. State & Federal / Medicare. | Medical and Behavioral Health Procedure Codes Requiring Prior Authorization: Providers please note that as of the 2/1/2022 Prior Authorization release, we are moving to one document that includes authorization requirements for Medical, Durable Medical Equipment, eviCore, and Behavioral Health rather than individual documents for each specialty. The site may not work properly. Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. 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. State & Federal / Medicare. Administrative. 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. | federal and Washington state civil rights laws. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use Availitys electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. 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. This form should only be used for Arkansas Blue Cross and Blue Shield members. To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Prior Authorization details for providers outside of WA/AK. In some cases, we require more information and will request additional records so we can make a fully informed decision. We want you to receive the best care at the right time and place. Independent licensees of the Blue Cross and Blue Shield Association. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. You are invited: Advancing Mental Health Equity for Youth & Young Adults. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. Some procedures may also receive instant approval. By filling out the form completely and with as much information as possible, you can be sure we have the information to process your request timely. Future updates regarding COVID-19 will appear in the monthly Provider News publication. 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. Deutsch | Other Blue Plans pre-authorization requirements may differ from ours. 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. We look forward to working with you to provide quality services to our members. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Let us know! 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). Step 9 At the top of page 2, provide the patients name and ID number. 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. Some procedures may also receive instant approval. Looks like you're using an old browser. In the event of an emergency, members may access emergency services 24/7. Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. 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. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. Find a Care Center. PPO outpatient services do not require Pre-Service Review. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. More prior authorization resources Sign in to Availity | | The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Please verify benefit coverage prior to rendering services. If you're concerned about losing coverage, we can connect you to the right options for you and your family. the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible Medical Policy and Prior Authorization for Blue Plans. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The resources for our providers may differ between states. Expand All Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. Therefore, its important for you to know your benefits and covered services. AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in New Hampshire. The CarelonRx member services telephone number is 833-279-0458. You can access the Precertification Lookup Tool through the Availity Portal. Contact CVS Caremark by phone at 844-345-3241 or visit their website. Use of the Anthem websites constitutes your agreement with our Terms of Use. Franais | 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. 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. 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). Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Independent licensees of the Blue Cross and Blue Shield Association. This tool is for outpatient services only. link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to Prior authorization is not a guarantee of payment. P | 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. 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. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. In Indiana: Anthem Insurance Companies, Inc. Kreyl Ayisyen | Oromoo | Carelon Medical Benefits Management, Inc. You are invited: Advancing Mental Health Equity for Youth & Young Adults, Reminder: Updated Carelon Medical Benefits Management, Inc. Musculoskeletal Program effective April 1, 2023 - Site of care reviews, Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update, Provider directory - annual audit for NCQA Accreditation, Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures, March is National Colorectal Cancer Awareness Month, Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews, Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023, Pharmacy information available on our provider website, Controlling High Blood Pressure and Submitting Compliant Readings, Shared savings and transition care management after inpatient discharges. Ting Vit | You understand and agree that by making any View requirements for group and Individual members on our commercial products. 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, 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. of all such websites. A new prior 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. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Have you reviewed your online provider directory information lately? 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Federal Employee Program. 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. Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. Portugus | Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. 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. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Our resources vary by state. Prior authorization is required for surgical services only. 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. Please verify benefit coverage prior to rendering services. 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 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. In Kentucky: Anthem Health Plans of Kentucky, Inc. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. 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. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). To stay covered, Medicaid members will need to take action. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Online - The AIM ProviderPortal is available 24x7. Your browser is not supported. Posted Jan. 11, 2021. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Information about COVID-19 and your insurance coverage. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). 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. In Kentucky: Anthem Health Plans of Kentucky, Inc. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for 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. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation In Maine: Anthem Health Plans of Maine, Inc. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Register today for the Advancing Mental Health Equity for Youth & Young Adults forum hosted by Anthem Blue Cross and Blue Shield (Anthem) and Motivo* for Anthem providers on March 15, 2023. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). L3927 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (for example, static or ring type), may include soft interface material, prefabricated, L5301 Below knee, molded socket, shin, SACH foot, endoskeletal system, L5321 Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee, L5645 Addition to lower extremity, below knee (BK), flexible inner socket, external frame, L5649 Addition to lower extremity, ischial containment/narrow M-L socket, L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each, 0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed, 0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure. Do you offer telehealth services? In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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. Sep 1, 2021 Sign in to the appropriate website to complete your request. On January 1, 2021, Anthem Blue Cross and Blue Shield prior authorization (PA) requirements will change for codes below. Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. 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. Once you choose to link to another website, you understand and agree that you have exited this Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). No, the need for emergency services does not require prior authorization. ), 0480T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure. With convenience in mind, Care Centers are at the heart of the patient health journey. We currently don't offer resources in your area, but you can select an option below to see information for that state. Do not sell or share my personal information. Oct 1, 2020 Prior approval for requested services - Arkansas Blue Cross and Blue Shield Prior approval for requested services The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Independent licensees of the Blue Cross Association. Choose your location to get started. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. You can also refer to the provider manual for information about services that require prior authorization. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. Please update your browser if the service fails to run our website. View medication policies and pre-authorization requirements. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. 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. By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. 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. 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 the search tool to find the Care Center closest to you. | View tools for submitting prior authorizationsfor Medicare Advantage members. March 2023 Anthem Provider News - New Hampshire. 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. In Indiana: Anthem Insurance Companies, Inc.
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