anthem blue cross prior authorization list

Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. Polski | Franais | To stay covered, Medicaid members will need to take action. View requirements for Basic Option, Standard Option and FEP Blue Focus. 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. Please verify benefit coverage prior to rendering services. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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 Maine: Anthem Health Plans of Maine, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Get Started To learn more read Microsoft's help article. Independent licensees of the Blue Cross Association. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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, You can also refer to the provider manual for information about services that require prior authorization. In Ohio: Community Insurance Company. View requirements for group and Individual members on our commercial products. Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. website. We look forward to working with you to provide quality services to our members. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to We want you to receive the best care at the right time and place. 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. . Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. 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. 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 Please verify benefit coverage prior to rendering services. The Blue Cross name and symbol are registered marks of the Blue Cross 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, Use the search tool to find the Care Center closest to you. We're here to work with you, your doctor and the facility so you have the best possible health outcome. Please refer to the criteria listed below for genetic testing. Availity is solely responsible for its products and services. P | Ting Vit | Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. PPO outpatient services do not require Pre-Service Review. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. Inpatient services and nonparticipating providers always require prior authorization. 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. If you're concerned about losing coverage, we can connect you to the right options for you and your family. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). 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 An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. In Indiana: Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Anthem partners with health care professionals to close gaps in care and improve members overall heath. Your plan has a list of services that require prior authorization. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. More prior authorization resources Sign in to Availity Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. 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. In Ohio: Community Insurance Company. Use Availitys electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Step 9 At the top of page 2, provide the patients name and ID number. 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. 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. In Connecticut: Anthem Health Plans, Inc. Other Blue Plans pre-authorization requirements may differ from ours. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content Italiano | Contact 866-773-2884 for authorization regarding treatment. 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. A new prior The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. No, the need for emergency services does not require prior authorization. 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 content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. View tools for submitting prior authorizationsfor Medicare Advantage members. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. 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. It looks like you're in . Important: Blueprint Portal will not load if you are using Internet Explorer. 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. Administrative. All rights reserved. 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. March 2023 Anthem Provider News - New Hampshire. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. may be offered to you through such other websites or by the owner or operator of such other websites. Sign in to the appropriate website to complete your request. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. We also want to ensure you receive the right technology that addresses your particular clinical issue. View pre-authorization requirements for UMP members. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. 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 Blue Shield: Health Insurance, Medicare & More Stay Covered When Medicaid Renewals Begin Medicaid renewals will start again soon. | federal and Washington state civil rights laws. 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. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. In Maine: Anthem Health Plans of Maine, Inc. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Looks like you're using an old browser. Do you offer telehealth services? Independent licensees of the Blue Cross and Blue Shield Association. Medical Policy and Prior Authorization for Blue Plans. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. FEP Basic Option/Standard OptionFEP Blue Focus. State & Federal / Medicare. | The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use these lists to identify the member services that require prior authorization. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Non-individual members Use Availity to submit prior authorizations and check codes. In Indiana: Anthem Insurance Companies, Inc. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . Select Auth/Referral Inquiry or Authorizations. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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). 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. Updated June 02, 2022. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Deutsch | Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. The resources for our providers may differ between states. 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. ), 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation, 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach, 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach, 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach, 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy), 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis, 33419 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure), 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed, 33979 Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle, 33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only, 36514 Therapeutic Apheresis; Plasma Pheresis, 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection, 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed, A4224 Supplies for maintenance of insulin infusion catheter, per week, A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each, A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe, A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fah, A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each, A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries, C1722 Cardioverter-defibrillator, single chamber (implantable), L5671 Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert, L5673 Addition to lower extremity, below knee/above knee, custom fabricated, L5679 Addition to lower extremity, below knee/above knee, custom fabricated, L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature, L5981 All lower extremity prostheses, flex-walk system or equal, L5987 All lower extremity prostheses, shank foot system with vertical loading pylon, L8699 Prosthetic implant, not otherwise specified, L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code. 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 Indiana: Anthem Insurance Companies, Inc. Your dashboard may experience future loading problems if not resolved. The CarelonRx member services telephone number is 833-279-0458. 2022 Electronic Forms LLC. Once you choose to link to another website, you understand and agree that you have exited this Access eligibility and benefits information on the Availity Web Portal or 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. | Your browser is not supported. of all such websites. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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 . URAC Accredited - Health Plan with Health Insurance Marketplace (HIM) - 7.3, URAC Accredited - Health Utilization Management - 7.4, Member forms - Individual and family plans, Coverage policy and pre-certification/pre-authorization, Approval information for radiological services, Medicare Advantage Prior Authorization Request Form, Part B Medication Prior Approval Request Form, Check deductible and out-of-pocket totals. Please update your browser if the service fails to run our website. We currently don't offer resources in your area, but you can select an option below to see information for that state. Federal Employee Program. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Prior Authorization details for providers outside of WA/AK. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. 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. 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. Our resources vary by state. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. In Maine: Anthem Health Plans of Maine, Inc. 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. Noncompliance with new requirements may result in denied claims. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. The site may not work properly. 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've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. color, national origin, age, disability, sex, gender identity, or sexual orientation. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. Oromoo | Prior authorization is required for surgical services only.

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