The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Provider Communications Use our app, Sydney Health, to start a Live Chat. Choose your location to get started. 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. 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. Find drug lists, pharmacy program information, and provider resources. 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. 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. Select Your State While the clinical UM guidelines developed by us are published on this web site, the licensed standard and customized MCG guidelines are proprietary to MCG and are not published on the Internet site. In Connecticut: Anthem Health Plans, Inc. Reimbursement Policies. 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 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. Copyright 2023. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Choose your state below so that we can provide you with the most relevant information. 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. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. 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. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. 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. 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. 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. Access to the information does not require an Availity role assignment, tax ID or NPI. 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. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. 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") Enter a CPT or HCPCS code in the space below. 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. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. 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. 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. The tool will tell you if that service needs . We want to help physicians, facilities and other health care professionals submit claims accurately. 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. Select Auth/Referral Inquiry or Authorizations. 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. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. 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. They are not agents or employees of the Plan. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Medicaid renewals will start again soon. Find out if a service needs prior authorization. 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). registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. Your dashboard may experience future loading problems if not resolved. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. It does not reflect benefits coverage, nor does it include an exhaustive listing of all non-covered services (in other words, experimental procedures, cosmetic surgery, etc.). Prior Authorization Lookup Tool - Anthem Blue Cross You can also visit. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. New member? It looks like you're outside the United States. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Our resources vary by state. We offer flexible group insurance plans for any size business. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. You can also visit bcbs.com to find resources for other states. The resources on this page are specific to your state. Quickly and easily submit out-of-network claims online. Inpatient services and non-participating providers always require prior authorization. If you arent registered to use Availity, signing up is easy and 100% secure. We offer affordable health, dental, and vision coverage to fit your budget. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. In Connecticut: Anthem Health Plans, Inc. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. If youre concerned about losing coverage, we can connect you to the right options for you and your family. Access eligibility and benefits information on the Availity* Portal OR. Interested in joining our provider network? Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. 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 Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. You must log in or register to reply here. In Ohio: Community Insurance Company. Precertification lookup tool | Anthem Start a Live Chat with one of our knowledgeable representatives. All other available Medical Policy documents are published by policy/topic title. 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. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. Type at least three letters and well start finding suggestions for you. It looks like you're in . Additional medical policies may be developed from time to time and some may be withdrawn from use. We currently don't offer resources in your area, but you can select an option below to see information for that state. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Independent licensees of the Blue Cross and Blue Shield Association. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. For a better experience, please enable JavaScript in your browser before proceeding. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Out-of-state providers. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. Type at least three letters and we will start finding suggestions for you. Pay outstanding doctor bills and track online or in-person payments. The notices state an overpayment exists and Anthem is requesting a refund. Access your member ID card from our website or mobile app. In Indiana: Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks 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. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Our resources vary by state. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. It looks like you're in . We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Health equity means that everyone has the chance to be their healthiest. We currently don't offer resources in your area, but you can select an option below to see information for that state. We are also licensed to use MCG guidelines to guide utilization management decisions. If your state isn't listed, check out bcbs.com to find coverage in your area. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. Members should discuss the information in the clinical UM guideline with their treating health care providers. Click Submit. Use the Prior Authorization tool within Availity. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Review medical and pharmacy benefits for up to three years. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More It looks like you're in . ET. 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. We look forward to working with you to provide quality services to our members. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. Search by keyword or procedure code for related policy information. Inpatient services and non-participating providers always require prior authorization. It looks like you're outside the United States. We look forward to working with you to provide quality service for our members. Medical policies can be highly technical and complex and are provided here for informational purposes. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Find drug lists, pharmacy program information, and provider resources. 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. New member? Administrative / Digital Tools, Learn more by attending this live webinar. You are using an out of date browser. Our resources vary by state. If this is your first visit, be sure to check out the. 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 currently don't offer resources in your area, but you can select an option below to see information for that state. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Use the Prior Authorization tool within Availity OR. Please verify benefit coverage prior to rendering services. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Independent licensees of the Blue Cross and Blue Shield Association. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 711. These guidelines do not constitute medical advice or medical care. 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.
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