Contact 866-773-2884 for authorization regarding treatment. This step will help you determine if prior authorization may be required for a specific member and service. These documents contain information about your benefits, network and coverage. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. There are three variants; a typed, drawn or uploaded signature. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. With three rich options to choose from, weve got you covered. 2005 - 2022 copyright 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. 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 You can also check status of an existing request and auto-authorize more than 40 common procedures. 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. 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. 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. 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 Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. CareFirst Medicare Advantage requires notification/prior authorization of certain services. To view this file, you may need to install a PDF reader program. Administrative. Referencing the . 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. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Musculoskeletal (eviCore): 800-540-2406. 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., 2022. Scroll down to the table of contents. Information to help you maximize your performance in our quality programs. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. February 2023 Anthem Provider News - Virginia, New ID cards for Anthem Blue Cross and Blue Shield members - Virginia, Telephonic-only care allowance extended through April 11, 2023 - Virginia, January 2023 Anthem Provider News - Virginia, December 2022 Anthem Provider News - Virginia, Medicare Advantage Providers | Anthem.com, March 2022 Anthem Provider News - Virginia, K1022 Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. Future updates regarding COVID-19 will appear in the monthly Provider News publication. 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). The site may also contain non-Medicare related information. CoverKids. 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. Anthem does not require prior authorization for treatment of emergency medical conditions. Please refer to the criteria listed below for genetic testing. 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. 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). 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. Electronic authorizations. If you have any questions, call the number on the members ID card. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. For your convenience, we've put these commonly used documents together in one place. 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. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. Any drugs, services, treatment, or supplies that the CareFirst medical staff determines, with appropriate consultation, to be experimental, investigational or unproven are not covered services. These documents contain information about upcoming code edits. 494 0 obj <>stream External link You are leaving this website/app (site). Forms and information about pharmacy services and prescriptions for your patients. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Anthem is a registered trademark of Anthem Insurance Companies, Inc. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross name and symbol are registered marks of the Blue Cross Association. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. Third-Party Liability (TPL) Forms. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Please check your schedule of benefits for coverage information. Details about new programs and changes to our procedures and guidelines. 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). eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Providers should continue to verify member eligibility and benefits prior to rendering services. You'll also find news and updates for all lines of business. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Providers should continue to verify member eligibility and benefits prior to rendering services. As your health needs evolve, our diverse plans are designed to evolve with you. 451 0 obj <> endobj Choose My Signature. 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 list. Independent licensees of the Blue Cross Association. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. The prior authorization information in this notice does not apply to requests for HMO members. You'll also find news and updates for all lines of business. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. In Connecticut: Anthem Health Plans, Inc. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. %%EOF 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Summaries and code lists are posted as a reference to help you determine when prior authorization may be required for non-HMO government programs members. This approval process is called prior authorization. In Indiana: Anthem Insurance Companies, Inc. Some procedures may also receive instant approval. This new site may be offered by a vendor or an independent third party. For costs and complete details of the coverage, please contact your agent or the health plan. 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 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. 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. 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