Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Out-of-area providers In Maine: Anthem Health Plans of Maine, Inc. Independent licensees of the Blue Cross and Blue Shield Association. 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. 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. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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). It looks like you're in . You can access the Precertification Lookup Tool through the Availity Portal. 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. Deutsch | In Indiana: Anthem Insurance Companies, Inc. 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. Non-individual members Use Availity to submit prior authorizations and check codes. More prior authorization resources Sign in to Availity 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. Online - The AIM ProviderPortal is available 24x7. 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. Medical Policy and Prior Authorization for Blue Plans. 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. This form should only be used for Arkansas Blue Cross and Blue Shield members. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. 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. 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). In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. The CarelonRx member services telephone number is 833-279-0458. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. 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. All rights reserved. This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. With convenience in mind, Care Centers are at the heart of the patient health journey. An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Use of the Anthem websites constitutes your agreement with our Terms of Use. ), 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. In Indiana: Anthem Insurance Companies, Inc. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Franais | 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. 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. Inpatient services and nonparticipating providers always require prior authorization. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. 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. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Maine: Anthem Health Plans of Maine, Inc. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. 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. 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. Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. View the FEP-specific code list and forms. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Other Blue Plans pre-authorization requirements may differ from ours. Updated June 02, 2022. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Information about COVID-19 and your insurance coverage. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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 Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. State & Federal / Medicare. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible You can also refer to the provider manual for information about services that require prior authorization. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members 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. We look forward to working with you to provide quality services to our members. Your plan has a list of services that require prior authorization. If yes, provide the medication name, dosage, duration of therapy, and outcome. We look forward to working with you to provide quality service for our members. Posted Jan. 11, 2021. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. Typically, we complete this review within two business days, and notify you and your provider of our decision. Italiano | | 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. Log into the Members portal to view the status of your prior authorization under the Claims &Eligibility menu. 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. In Indiana: Anthem Insurance Companies, Inc. Find a Care Center. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. You are invited: Advancing Mental Health Equity for Youth & Young Adults. ), 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. Easily obtain pre-authorization and eligibility information with our tools. | Anthem is a registered trademark of Anthem Insurance Companies, Inc. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. If you're concerned about losing coverage, we can connect you to the right options for you and your family. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Stay Covered When Medicaid Renewals Begin Medicaid renewals will start again soon. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. View tools for submitting prior authorizationsfor Medicare Advantage members. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. . This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. We want you to receive the best care at the right time and place. We're here to work with you, your doctor and the facility so you have the best possible health outcome. Select Auth/Referral Inquiry or Authorizations. In the case of a medical emergency, you do not need prior authorization to receive care. Contact 866-773-2884 for authorization regarding treatment. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). In some cases, we require more information and will request additional records so we can make a fully informed decision. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Ohio: Community Insurance Company. 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. | 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. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Portugus | 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). 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. 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. nor state or imply that you should access such website or any services, products or information which The Blue Cross name and symbol are registered marks of the Blue Cross Association. In Kentucky: Anthem Health Plans of Kentucky, Inc. On January 1, 2021, Anthem Blue Cross and Blue Shield prior authorization (PA) requirements will change for codes below. 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.