View medication policies and pre-authorization requirements. We look forward to working with you to provide quality services to our members. Have you reviewed your online provider directory information lately? We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. | You can access the Precertification Lookup Tool through the Availity Portal. 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 merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content Oct 1, 2020 Anthem partners with health care professionals to close gaps in care and improve members overall heath. Anthem is a registered trademark of Anthem Insurance Companies, Inc. website and are no longer accessing or using any ABCBS Data. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). Administrative. Medical Policy and Prior Authorization for Blue Plans. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. 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. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. 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. In Ohio: Community Insurance Company. An Independent Licensee of the Blue Cross and Blue Shield Association, Summary of Benefits & Coverage Information, Sleep Testing and Therapy & Advanced Imaging, Confirm your specific treatment plan and medical necessity given your diagnosis, Determine if services are eligible for coverage, Assure your claims are processed accurately and timely, Save you from unnecessary medical expenses. Step 4 In Prescriber Information, specifythe prescribers full name, speciality, and full address. Independent licensees of the Blue Cross and Blue Shield Association. Use Availity to submit prior authorizations and check codes. The resources for our providers may differ between states. 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. The CarelonRx member services telephone number is 833-279-0458. View the FEP-specific code list and forms. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Please verify benefit coverage prior to rendering services. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. Complete all member information fields on this form: Complete either the denial or the termination information section. Please update your browser if the service fails to run our website. We're here to work with you, your doctor and the facility so you have the best possible health outcome. Check whether a prior authorization is needed Check the status of a prior authorization This information is also available in other ways to people with disabilities by calling customer service at (651) 662-8000 (voice), or 1-800-382-2000 (toll free). Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. federal and Washington state civil rights laws. In Ohio: Community Insurance Company. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. Independent licensees of the Blue Cross and Blue Shield Association. 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. In Indiana: Anthem Insurance Companies, Inc. To learn more read Microsoft's help article. Typically, we complete this review within two business days, and notify you and your provider of our decision. We look forward to working with you to provide quality service for our members. Italiano | Use the search tool to find the Care Center closest to you. Inpatient services and nonparticipating providers always require prior authorization. Prior authorization is required for surgical services only. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Your browser is not supported. Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. You can find the number on the back of your ID card, or you can write to us at the following address: Appeals and Grievance CoordinatorBlue Cross of IdahoPO Box 7408Boise, ID 83707. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members Portugus | 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. Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. Non-individual members Use Availity to submit prior authorizations and check codes. Electronic authorizations. 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, As healthcare costs go up, health insurance premiums also go up to pay for the services provided. Visit Anthem.com to learn more about how we coordinate our medical and pharmacy benefits, review our drug lists, submit prior authorization requests, and more. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Looks like you're using an old browser. 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. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. 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. Anthem does not require prior authorization for treatment of emergency medical conditions. It looks like you're outside the United States. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department 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 affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for If your state isn't listed, check out bcbs.com to find coverage in your area. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). In Maine: Anthem Health Plans of Maine, Inc. others in any way for your decision to link to such other websites. In Kentucky: Anthem Health Plans of Kentucky, Inc. Do not sell or share my personal information. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. benefit certificate to determine which services need prior approval. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. There is a list of these services in your member contract. The formcontains important information regarding the patients medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patients health care plan. 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. 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. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, L3925 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), non-torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf. | You understand and agree that by making any The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Online - The AIM ProviderPortal is available 24x7. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Please refer to the criteria listed below for genetic testing. Some procedures may also receive instant approval. Once you choose to link to another website, you understand and agree that you have exited this If you're concerned about losing coverage, we can connect you to the right options for you and your family. 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. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Independent licensees of the Blue Cross and Blue Shield Association. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, All rights reserved. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. This form should only be used for Arkansas Blue Cross and Blue Shield members. 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. 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). 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. Learn more about electronic authorization. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. Let us know! Noncompliance with new requirements may result in denied claims. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. Use these lists to identify the member services that require prior authorization. ABCBS makes no warranties or representations of any kind, express or implied, nor ), 0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed), 0466T Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure. This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. 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. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. In Maine: Anthem Health Plans of Maine, Inc. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. 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. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. You can also refer to the provider manual for information about services that require prior authorization. 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. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. If yes, provide the medication name, dosage, duration of therapy, and outcome. In Indiana: Anthem Insurance Companies, Inc. View requirements for Basic Option, Standard Option and FEP Blue Focus. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. March 2023 Anthem Provider News - New Hampshire, February 2023 Provider Newsletter - New Hampshire, Telephonic-only care allowance extended through April 11, 2023 - New Hampshire, January 2023 Provider Newsletter - New Hampshire, Reimbursement for services by clinical behavioral health providers seeking licensure, Time to prepare for HEDIS medical record review, New policy for EMR clinical data sharing and ADT notifications, Reimbursement policy update: Modifiers 25 and 57 - Professional, Specialty pharmacy updates for March 2023, Clinical Criteria updates for specialty pharmacy. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. In Indiana: Anthem Insurance Companies, Inc. . or operation of any other website to which you may link from this website. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). Some procedures may also receive instant approval. | 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. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. Select Auth/Referral Inquiry or Authorizations. It looks like you're in . Prior authorization suspension for Anthem Ohio in-network hospital transfers to in-network skilled nursing facilities effective December 20, 2022 to January 15, 2023: Prior authorization suspension - In-network hospital transfers to In-network SNFs . Contact 866-773-2884 for authorization regarding treatment. 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. View tools for submitting prior authorizationsfor Medicare Advantage members. 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 Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. To request authorizations: From the Availity home page, select Patient Registration from the top navigation. 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. | You are invited: Advancing Mental Health Equity for Youth & Young Adults. FEP Basic Option/Standard OptionFEP Blue Focus. nor state or imply that you should access such website or any services, products or information which To stay covered, Medicaid members will need to take action. Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. Franais | In Kentucky: Anthem Health Plans of Kentucky, Inc. Availity is solely responsible for its products and services. Get Started Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. With prior authorization, Blue Cross of Idaho is able to: Prior authorization is just one of the ways we're working to save our members money and address rising healthcare costs. Easily obtain pre-authorization and eligibility information with our tools. Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. If you receive services that are not medically necessary from one of Blue Cross of Idahos contracting providers without getting prior authorization and payment for the services is denied, you are not financially responsible. This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Deutsch | Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. Federal Employee Program. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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. Sign in to the appropriate website to complete your request. This may result in a delay of our determination response. Kreyl Ayisyen | Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card.

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