It looks like you're outside the United States. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. Find drug lists, pharmacy program information, and provider resources. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). We offer flexible group insurance plans for any size business. We currently don't offer resources in your area, but you can select an option below to see information for that state. You can also visit bcbs.com to find resources for other states. We look forward to working with you to provide quality services to our members. Your browser is not supported. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. You can also visit. You can also type part of the code's description to search, for example type "tonsil" to find "Removal of tonsils." This tool can be used to check if a prior authorization is required for health care services covered by Blue Cross and Blue Shield of Minnesota commercial health plans, Medicare Advantage and Platinum Blue. Apr 1, 2022 Available for iOS and Android devices. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. 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. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. 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 tool will tell you if that service needs . We look forward to working with you to provide quality services to our members. You can also visit bcbs.com to find resources for other states. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. This tool is for outpatient services only. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. The resources for our providers may differ between states. Find a Medicare plan that fits your healthcare needs and your budget. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. The Blue Cross name and symbol are registered marks of the Blue Cross Association. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. Call Provider Services at 1-800-454-3730 (TTY 711) After hours, verify member eligibility by calling the 24/7 Nurse HelpLine at 1-800-600-4441. Access eligibility and benefits information on the Availity* Portal OR. Use of the Anthem websites constitutes your agreement with our Terms of Use. We are also licensed to use MCG guidelines to guide utilization management decisions. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. To get started, select the state you live in. 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. Prior authorization lookup tool| HealthKeepers, Inc. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. It may not display this or other websites correctly. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Please verify benefit coverage prior to rendering services. Please Select Your State The resources on this page are specific to your state. Please verify benefit coverage prior to rendering services. If a prior authorization (PA) is required (indicates "yes" or "no") If there are PA conditions; If the service is a covered benefit (indicates "covered" or "not covered") Independent licensees of the Blue Cross Association. The resources for our providers may differ between states. Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization. Your dashboard may experience future loading problems if not resolved. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. Call our Customer Service number, (TTY: 711). You are using an out of date browser. Independent licensees of the Blue Cross and Blue Shield Association. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. The resources on this page are specific to your state. Other ways to access: If you are currently accessing the Pre-certification / Pre-Authorization Requirements list through your health plans public website, this option is still available for you. Our resources vary by state. Contact will be made by an insurance agent or insurance company. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. Choose your location to get started. Health equity means that everyone has the chance to be their healthiest. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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 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. We look forward to working with you to provide quality service for our members. Quickly and easily submit out-of-network claims online. Youll also strengthen your appeals with access to quarterly versions since 2011. 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. Where is the Precertification Lookup Tool located on Availity? We currently don't offer resources in your area, but you can select an option below to see information for that state. In Kentucky: Anthem Health Plans of Kentucky, Inc. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Copyright 2023. Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment, Indiana Medicaid Prior Authorization Requirements List, New Option Available for Indiana Market. If you are unsure or have any questions, please be sure to check member eligibility and benefit coverage before proceeding with any authorization requests or services by contacting Provider Services at 800-901-0020. New member? In Connecticut: Anthem Health Plans, Inc. This tool is for outpatient services only. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Select Auth/Referral Inquiry or Authorizations. 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. New member? We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. Current Procedural Terminology, more commonly known as CPT, refers to a medical code set created and maintained by the American Medical Association and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. Explore our resources. Interested in joining our provider network? Anthem offers great healthcare options for federal employees and their families. Future updates regarding COVID-19 will appear in the monthly Provider News publication. 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). Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Your browser is not supported. No provider of outpatient services gets paid without reporting the proper CPT codes. Make your mental health a priority. You can access the Precertification Lookup Tool through the Availity Portal. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Your dashboard may experience future loading problems if not resolved. We currently don't offer resources in your area, but you can select an option below to see information for that state. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. The purpose of this communication is the solicitation of insurance. Or You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). Type at least three letters and we will start finding suggestions for you. The resources for our providers may differ between states. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. 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. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. Inpatient services and non-participating providers always require prior authorization. For subsequent inpatient care, see 99231-99233. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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. Our resources vary by state. It looks like you're outside the United States. Access to the information does not require an Availity role assignment, tax ID or NPI. Not connected with or endorsed by the U.S. Government or the federal Medicare program. There is no cost for our providers to register or to use any of the digital applications. You can access the Precertification Lookup Tool through the Availity Portal. These guidelines do not constitute medical advice or medical care. Please note that services listed as requiring precertification may not be covered benefits for a member. There are several factors that impact whether a service or procedure is covered under a members benefit plan. March 2023 Anthem Provider News - Missouri, 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, April 2022 Anthem Provider News - Missouri, enable member benefit lookup by CPT and HCPC procedure codes, Enter up to eight procedure codes per transaction, provide additional cost share information by place of service, return Is Authorization Required? information, include additional plan-level benefit limitations. 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. Lets make healthy happen. Current Procedural Terminology, more commonly known as CPT, refers to a medical code set created and maintained by the American Medical Association and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. Choose your state below so that we can provide you with the most relevant information. State & Federal / Medicaid. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In Kentucky: Anthem Health Plans of Kentucky, Inc. Members should contact their local customer service representative for specific coverage information. We look forward to working with you to provide quality service for our members. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. 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. Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization. Understand your care options ahead of time so you can save time and money. We want to help physicians, facilities and other health care professionals submit claims accurately. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. Prior Authorization Lookup. We look forward to working with you to provide quality service for our members. E0731 Conductive garment for Tens 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 Provider Medical Policies | Anthem.com Find information that's tailored for you. Review medical and pharmacy benefits for up to three years. In Maine: Anthem Health Plans of Maine, Inc. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. 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. After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-224-0336. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. 711. Reimbursement Policies. 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. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Select Your State Anthem is a registered trademark of Anthem Insurance Companies, Inc. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) If your state isn't listed, check out bcbs.com to find coverage in your area. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Large Group For a better experience, please enable JavaScript in your browser before proceeding. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. The resources on this page are specific to your state. We look forward to working with you to provide quality service for our members. The notices state an overpayment exists and Anthem is requesting a refund. Explore programs available in your state. Inpatient services and non-participating Anthem HealthKeepers Plus providers always 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. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manualand support for delivering benefits to our members. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. In Maine: Anthem Health Plans of Maine, Inc. 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. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. In Ohio: Community Insurance Company. With Codify by AAPC cross-reference tools, you can check common code pairings. 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 Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Search by keyword or procedure code for related policy information. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans A group NPI cannot be used as ordering NPI on a Medicare claim. Start a Live Chat with one of our knowledgeable representatives. If this is your first visit, be sure to check out the. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. They are not agents or employees of the Plan. Additional medical policies may be developed from time to time and some may be withdrawn from use. Members should discuss the information in the medical policies with their treating health care professionals. Please update your browser if the service fails to run our website. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. It looks like you're outside the United States. Enter one or more keyword (s) for desired policy or topic. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Members should discuss the information in the clinical UM guideline with their treating health care providers. Choose your state below so that we can provide you with the most relevant information. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. The MCG guidelines we are licensed to use include ((1) Inpatient & Surgical Care (ISC), (2) General Recovery Care (GRG), (3) Recovery Facility Care (RFC), (4) Chronic Care (CC) and (5) Behavioral Health Care Guidelines (BHG). The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Enter a CPT or HCPCS code in the space below. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Jan 1, 2020 Plus, you may qualify for financial help to lower your health coverage costs. Please update your browser if the service fails to run our website. Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Price a medication, find a pharmacy,order auto refills, and more. We currently don't offer resources in your area, but you can select an option below to see information for that state. Reaching out to Anthem at least here on our. Vaccination is important in fighting against infectious diseases. Use our app, Sydney Health, to start a Live Chat. The Precertification Lookup Tool will let you know if clinical edits apply, information such as the medical necessity criteria used in making the authorization decision, and if a vendor is used -- without the need to make a phone call. 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. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare, Keyword database enhanced with medical acronyms and terminology, Default settings to lock in your preference for code-centered or range pages, Code Constructor to narrow down your code options one clickable range at a time, Lay terms and CPT code update information, An expanded index by service eases looking for a procedure or service. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Your dashboard may experience future loading problems if not resolved. We currently don't offer resources in your area, but you can select an option below to see information for that state. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. 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. This tool is for outpatient services only. Do not sell or share my personal information. In Ohio: Community Insurance Company. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Connecticut: Anthem Health Plans, Inc. 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 were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Our resources vary by state. The doctors, hospitals, and other providers which are part of the network of providers referred to in this document are independent contractors who exercise independent judgment and over whom we have no control or right of control. Access resources to help health care professionals do what they do bestcare for our members. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Start by logging onto Availity.com and selecting the Register icon at the top of the home screen or use this link to access the registration page. Type at least three letters and well start finding suggestions for you. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. If you arent registered to use Availity, signing up is easy and 100% secure. Were committed to supporting you in providing quality care and services to the members in our network. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Independent licensees of the Blue Cross and Blue Shield Association. We currently don't offer resources in your area, but you can select an option below to see information for that state. Choose your state below so that we can provide you with the most relevant information. Medicare Complaints, Grievances & Appeals. It looks like you're in . Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 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. Taking time for routine mammograms is an important part of staying healthy. Choose your location to get started. Use of the Anthem websites constitutes your agreement with our Terms of Use. Directions. The COVID19 pandemic and nationwide shutdown that started in March 2020 placed a spotlight on crisis preparedness within the U.S. hea Dont assume the codes youve been using to report drugs and biologicals still apply. 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. out of your benefits, find the best healthcare, and stay healthy. Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started. Your browser is not supported. You can also visit bcbs.com to find resources for other states. 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. Inpatient services and non-participating providers always require prior authorization. We update the Code List to conform to the most recent publications of CPT and HCPCS . You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed.