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. Non-individual members Use Availity to submit prior authorizations and check codes. In Maine: Anthem Health Plans of Maine, Inc. 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. Our resources vary by state. 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. 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, In Kentucky: Anthem Health Plans of Kentucky, Inc. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. 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. 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 Learn more about electronic authorization. Federal Employee Program. Find care, claims & more with our new app. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. 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. Future updates regarding COVID-19 will appear in the monthly Provider News publication. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. We want you to receive the best care at the right time and place. 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. Some procedures may also receive instant approval. under any circumstances for the activities, omissions or conduct of any owner or operator of any other Once you choose to link to another website, you understand and agree that you have exited this Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). Please verify benefit coverage prior to rendering services. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. 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. 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. To stay covered, Medicaid members will need to take action. Kreyl Ayisyen | State & Federal / Medicare. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Polski | ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. ), 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. In Connecticut: Anthem Health Plans, Inc. Independent licensees of the Blue Cross and Blue Shield Association. 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. Complete all member information fields on this form: Complete either the denial or the termination information section. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Use the search tool to find the Care Center closest to you. You can access the Precertification Lookup Tool through the Availity Portal. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Your plan has a list of services that require prior authorization. | You can also visit, Standard Local Prior Authorization Code List, Standard Prior Authorization Requirements, SHBP Precertification Procedure Codes Sheet, SHBP Co-pay/Co-insurance Waiver Medication List. View pre-authorization requirements for UMP members. Please refer to the criteria listed below for genetic testing. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. Easily obtain pre-authorization and eligibility information with our tools. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. In Maine: Anthem Health Plans of Maine, Inc. Type at least three letters and we will start finding suggestions for you. Select Auth/Referral Inquiry or Authorizations. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. Do not sell or share my personal information. In Ohio: Community Insurance Company. In Ohio: Community Insurance Company. Noncompliance with new requirements may result in denied claims. Sign in to the appropriate website to complete your request. Contact 866-773-2884 for authorization regarding treatment. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, If you have any questions regarding our Utilization Management or Prior Authorization process, please call Customer Service at the number on the back of your identification card and they can answer any general inquiries you may have. 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. others in any way for your decision to link to such other websites. We look forward to working with you to provide quality services to our members. Medical Policy and Clinical Guideline updates are available on our provider website, AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update, Enhancing Provider News website and email communications, Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements, Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines, Specialty pharmacy updates - February 2023, City of Manchester Offers Medicare Advantage Option - New Hampshire, Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023, 2023 FEP benefit information available online, Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Fylnetra), Telephonic-only care allowance extended through April 11, 2023, Anthem Blue Cross and Blue Shield local precertification change in New Hampshire, Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines, New specialty pharmacy medical step therapy requirements, Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list, Notification regarding reimbursement changes to COVID-19 laboratory services codes, Submitting prior authorizations digitally through Interactive Care Reviewer, Outpatient facility revenue code billing requirements, AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update, Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List, Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines, Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines, Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines - Material adverse change, Medical policy and clinical guideline updates available on our provider website, Federal Employee Program observation conversion for musculoskeletal cases, Remittance advice message enhancements: Providing clear descriptions and actionable next steps, Childhood Immunization Status and Lead Screening in Children for HEDIS, Attention lab providers: COVID-19 update regarding reimbursement, December 2022 Provider Newsletter - New Hampshire, Important information about utilization management, IngenioRx will become CarelonRx on January 1, 2023, Reimbursement policy retirement: Acupuncture Billed with Evaluation and Management - Professional, Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility, Reimbursement policy update: Bundled Services and Supplies - Professional, Manchester School District in New Hampshire moves to the Medicare Advantage plan with Anthem Blue Cross and Blue Shield, 2023 Medicare Advantage service area and benefit updates, Signature requirements for laboratory orders or requisitions, Reminder - updated AIM Musculoskeletal program effective January 1, 2023 - site of care reviews, Specialty pharmacy updates - December 2022, AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT Code List update, Member assessment of PCP after-hours messaging in 2022, Members assessment of behavioral healthcare after-hours messaging in 2022, CAA: Timely updates help keep our provider directories current, Clinical practice and preventive health guidelines available on anthem.com, Pharmacy information available on the provider website, PCP searches in Find Care - New Hampshire, Support documentation for AIM prior authorization requests, November 2022 Provider Newsletter - New Hampshire, Claims status message enhancements: providing clear descriptions and actionable next steps, Submit digital attachments within seven-calendar days for claims filed with a PWK segment indicator, You can now submit one electronic claim dispute for multiple claims and access correspondence digitally, too, Visit the Provider Learning Hub to view our latest learning opportunities, Correction to reimbursement policy: Place of Service - Facility, Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline, Medical policy and clinical guideline updates available on anthem.com, Medical drug benefit Clinical Criteria updates, Post office boxes being retired because of low usage, Specialty pharmacy updates - November 2022, CAA: Keep your provider directory information up to date, Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022, COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022, Register for our upcoming CME webinar about low back pain management, CME webinar about low back pain management - New Hampshire, October 2022 Provider Newsletter - New Hampshire. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Italiano | P | For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. March 2023 Anthem Provider News - New Hampshire. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. In Indiana: Anthem Insurance Companies, Inc. View the FEP-specific code list and forms. Our electronic prior authorization (ePA) process is the preferred method for . Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Anthem partners with health care professionals to close gaps in care and improve members overall heath. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. If you choose to access other websites from this website, you agree, as a condition of choosing any such 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. Online - The AIM ProviderPortal is available 24x7. 2022 Electronic Forms LLC. View requirements for Basic Option, Standard Option and FEP Blue Focus. 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. 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. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. 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. Deutsch | 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 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. Prior Authorization Medication management With input from community physicians, specialty societies, and our Pharmacy & Therapeutics Committee, which includes community physicians and pharmacists from across the state, we design programs to help keep prescription drug coverage affordable. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. With convenience in mind, Care Centers are at the heart of the patient health journey. of all such websites. FEP Basic Option/Standard OptionFEP Blue Focus. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. Type at least three letters and well start finding suggestions for you. Let us know! Find a Care Center. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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). 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. may be offered to you through such other websites or by the owner or operator of such other websites. nor state or imply that you should access such website or any services, products or information which 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. In the case of an emergency, you do not need prior authorization. 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. You are invited: Advancing Mental Health Equity for Youth & Young Adults. 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). federal and Washington state civil rights laws. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . Your dashboard may experience future loading problems if not resolved. 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. More prior authorization resources Sign in to Availity 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. Updated June 02, 2022. Independent licensees of the Blue Cross and Blue Shield Association. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. If yes, provide the medication name, dosage, duration of therapy, and outcome. View tools for submitting prior authorizationsfor Medicare Advantage members. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Inpatient services and nonparticipating providers always require prior authorization. If your state isn't listed, check out bcbs.com to find coverage in your area. In Indiana: Anthem Insurance Companies, Inc. We're here to work with you, your doctor and the facility so you have the best possible health outcome. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. Use Availity to submit prior authorizations and check codes. An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. 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 . We look forward to working with you to provide quality service for our members. Please update your browser if the service fails to run our website. It looks like you're outside the United States. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). website and are no longer accessing or using any ABCBS Data. In Connecticut: Anthem Health Plans, Inc. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. You further agree that ABCBS and its 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. Have you reviewed your online provider directory information lately? If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. In Ohio: Community Insurance Company. If you're concerned about losing coverage, we can connect you to the right options for you and your family. To learn more read Microsoft's help article. Ting Vit | Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. Typically, we complete this review within two business days, and notify you and your provider of our decision. Prior authorization is required for surgical services only. In the event of an emergency, members may access emergency services 24/7. Medical Policy and Prior Authorization for Blue Plans. The Blue Cross name and symbol are registered marks of the Blue Cross Association. o Massachusetts Collaborative Prior Authorization Form or o Blue Cross Blue Shield of Massachusetts Pre-certification Request Form Click on the title for complete list of drugs that require prior authorization: Medical Benefit Prior Authorization Medication List, #034 Medical Utilization Management and Pharmacy Prior Authorization, #033 Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members 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. Oct 1, 2020 The resources for our providers may differ between states. Sep 1, 2021 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. In Connecticut: Anthem Health Plans, Inc. 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. | You can also refer to the provider manual for information about services that require prior authorization. Inpatient services and nonparticipating providers always require prior authorization. A new prior The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. | Sign in to the appropriate website to complete your request. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation Other Blue Plans pre-authorization requirements may differ from ours. 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. This may result in a delay of our determination response. 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. In Ohio: Community Insurance Company. Posted Jan. 11, 2021. There is a list of these services in your member contract. Get Started | In Indiana: Anthem Insurance Companies, Inc. 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. 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. ), 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. We look forward to working with you to provide quality services to our members. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. Contact CVS Caremark by phone at 844-345-3241 or visit their website. 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.
