Please verify benefit coverage prior to rendering services. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manualand support for delivering benefits to our members. We look forward to working with you to provide quality services to our members. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. You can also visit. Anthem offers great healthcare options for federal employees and their families. Independent licensees of the Blue Cross Association. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. 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. 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 research shows that subscribers using Codify by AAPC are 33% more productive. The Precertification Lookup Tool will let you know if clinical edits apply, information such as the medical necessity criteria used in making the authorization decision, and if a vendor is used -- without the need to make a phone call. 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. The resources on this page are specific to your state. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. 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. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. The purpose of this communication is the solicitation of insurance. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Choose your location to get started. Please Select Your State The resources on this page are specific to your state. Pay outstanding doctor bills and track online or in-person payments. For costs and complete details of the coverage, please contact your agent or the health plan. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. The Blue Cross name and symbol are registered marks of the Blue Cross 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") In Maine: Anthem Health Plans of Maine, Inc. You can access the Precertification Lookup Tool through the Availity Portal. These guidelines do not constitute medical advice or medical care. Inpatient services and nonparticipating providers always require prior authorization. Out-of-state providers. Review medical and pharmacy benefits for up to three years. In Indiana: Anthem Insurance Companies, Inc. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 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. Find drug lists, pharmacy program information, and provider resources. A group NPI cannot be used as ordering NPI on a Medicare claim. For a better experience, please enable JavaScript in your browser before proceeding. Enter one or more keyword (s) for desired policy or topic. It may not display this or other websites correctly. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. The resources for our providers may differ between states. We look forward to working with you to provide quality service for our members. Independent licensees of the Blue Cross and Blue Shield Association. 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. Inpatient services and non-participating providers always require prior authorization. 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. Additional medical policies may be developed from time to time and some may be withdrawn from use. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. ET. Members should discuss the information in the clinical UM guideline with their treating health care providers. Select Auth/Referral Inquiry or Authorizations. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). It looks like you're outside the United States. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. The resources for our providers may differ between states. Find answers to all your questions with an Anthem representative in real time. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. Enter a CPT or HCPCS code in the space below. Access resources to help health care professionals do what they do bestcare for our members. Members should discuss the information in the medical policies with their treating health care professionals. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. These documents are available to you as a reference when interpreting claim decisions. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Please note that services listed as requiring precertification may not be covered benefits for a member. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. All other available Medical Policy documents are published by policy/topic title. Access your member ID card from our website or mobile app. Find drug lists, pharmacy program information, and provider resources. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare, Keyword database enhanced with medical acronyms and terminology, Default settings to lock in your preference for code-centered or range pages, Code Constructor to narrow down your code options one clickable range at a time, Lay terms and CPT code update information, An expanded index by service eases looking for a procedure or service. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Prior authorizations are required for: All non-par providers. Choose your state below so that we can provide you with the most relevant information. 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. Independent licensees of the Blue Cross and Blue Shield Association. Type at least three letters and well start finding suggestions for you. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Reaching out to Anthem at least here on our. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. Once youve accessed the Precertification Lookup Tool, choose a line of business from the menu selection offered, and then type the CPT/HCPCS code or a code description to determine if a prior authorization is required. 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. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. It looks like you're in . In Ohio: Community Insurance Company. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. You can also visit. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Your dashboard may experience future loading problems if not resolved. If youre concerned about losing coverage, we can connect you to the right options for you and your family. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, 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. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. The resources for our providers may differ between states. Anthem is a registered trademark of Anthem Insurance Companies, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. They are not agents or employees of the Plan. Explore programs available in your state. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. There is no cost for our providers to register or to use any of the digital applications. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. In Kentucky: Anthem Health Plans of Kentucky, Inc. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. Not connected with or endorsed by the U.S. Government or the federal Medicare program. 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 Connecticut: Anthem Health Plans, Inc. 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. Please note: This tool is for outpatient services only. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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 resources for our providers may differ between states. Contact will be made by an insurance agent or insurance company. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. The resources on this page are specific to your state. Access to the information does not require an Availity role assignment, tax ID or NPI. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Find a Medicare plan that fits your healthcare needs and your budget. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. 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.). 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. In Ohio: Community Insurance Company. You can also visit bcbs.com to find resources for other states. 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. You must log in or register to reply here. Health equity means that everyone has the chance to be their healthiest. 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. Audit reveals crisis standards of care fell short during pandemic. 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. 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. 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. Compare plans available in your area and apply today. Were committed to supporting you in providing quality care and services to the members in our network. Choose your location to get started. 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. Quickly and easily submit out-of-network claims online. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Large Group February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. We currently don't offer resources in your area, but you can select an option below to see information for that state. Choose your location to get started. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. The medical policies do not constitute medical advice or medical care. 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. Choose your location to get started. Make your mental health a priority. We currently don't offer resources in your area, but you can select an option below to see information for that state. We currently don't offer resources in your area, but you can select an option below to see information for that state. The resources for our providers may differ between states. It looks like you're in . Please verify benefit coverage prior to rendering services. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). State & Federal / Medicaid. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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). They are not agents or employees of the Plan. Medicare Complaints, Grievances & Appeals. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. In Indiana: Anthem Insurance Companies, Inc. Choose your state below so that we can provide you with the most relevant information. 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. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. 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. For subsequent inpatient care, see 99231-99233. We look forward to working with you to provide quality services to our members. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Choose your location to get started. 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. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. 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. Lets make healthy happen. The tool will tell you if that service needs . Start a Live Chat with one of our knowledgeable representatives. Please verify benefit coverage prior to rendering services. Your online account is a powerful tool for managing every aspect of your health insurance plan. Prior Authorization Lookup. Our resources vary by state. Our resources vary by state. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. 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. out of your benefits, find the best healthcare, and stay healthy. To get started, select the state you live 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. 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. Use the Prior Authorization tool within Availity OR. To stay covered, Medicaid members will need to take action. New member? Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Jan 1, 2020 If your state isn't listed, check out bcbs.com to find coverage in your area. Type at least three letters and we will start finding suggestions for you. You can access the Precertification Lookup Tool through the Availity Portal. Choose your state below so that we can provide you with the most relevant information. Search by keyword or procedure code for related policy information. 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. If you arent registered to use Availity, signing up is easy and 100% secure. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Select a State Policies & Guidelines Medical Policies & Clinical UM Guidelines There are several factors that impact whether a service or procedure is covered under a member's benefit plan. Inpatient services and non-participating providers always require prior authorization. Our resources vary by state. Copyright 2023. Vaccination is important in fighting against infectious diseases. Understand your care options ahead of time so you can save time and money. We offer affordable health, dental, and vision coverage to fit your budget. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. We look forward to working with you to provide quality services to our members. 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. Here you'll find information on the available plans and their benefits. Inpatient services and non-participating providers always require prior authorization. Administrative / Digital Tools, Learn more by attending this live webinar. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. You can also type part of the code's description to search, for example type "tonsil" to find "Removal of tonsils." This tool can be used to check if a prior authorization is required for health care services covered by Blue Cross and Blue Shield of Minnesota commercial health plans, Medicare Advantage and Platinum Blue. We currently don't offer resources in your area, but you can select an option below to see information for that state. Our resources vary by state. Interested in joining our provider network? Youll also strengthen your appeals with access to quarterly versions since 2011. Find out if a service needs prior authorization. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. In Maine: Anthem Health Plans of Maine, Inc. Please update your browser if the service fails to run our website. Members should contact their local customer service representative for specific coverage information. In Kentucky: Anthem Health Plans of Kentucky, 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. Your dashboard may experience future loading problems if not resolved. Members should contact their local customer service representative for specific coverage information. Available for iOS and Android devices. Use of the Anthem websites constitutes your agreement with our Terms of Use. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Select Your State registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. In Connecticut: Anthem Health Plans, Inc. Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. 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.

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