We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Please verify benefit coverage prior to rendering services. The tool will tell you if that service needs . ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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). The notices state an overpayment exists and Anthem is requesting a refund. 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. Find out if a service needs prior authorization. Our resources vary by state. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. In Ohio: Community Insurance Company. To stay covered, Medicaid members will need to take action. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. 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. 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. 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. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Understand your care options ahead of time so you can save time and money. This tool is for outpatient services only. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Anthem is a registered trademark of Anthem Insurance Companies, Inc. You can access the Precertification Lookup Tool through the Availity Portal. You can access the Precertification Lookup Tool through the Availity Portal. Access to the information does not require an Availity role assignment, tax ID or NPI. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Interested in joining our provider network? The COVID19 pandemic and nationwide shutdown that started in March 2020 placed a spotlight on crisis preparedness within the U.S. hea Dont assume the codes youve been using to report drugs and biologicals still apply. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Not connected with or endorsed by the U.S. Government or the federal Medicare program. The resources for our providers may differ between states. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Please note: This tool is for outpatient services only. Our resources vary by state. Independent licensees of the Blue Cross Association. Choose your location to get started. Youll also strengthen your appeals with access to quarterly versions since 2011. 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. Price a medication, find a pharmacy,order auto refills, and more. Please update your browser if the service fails to run our website. Your browser is not supported. 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. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. We are also licensed to use MCG guidelines to guide utilization management decisions. In Indiana: Anthem Insurance Companies, Inc. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. The resources for our providers may differ between states. They are not agents or employees of the Plan. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. Select Your State Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Health equity means that everyone has the chance to be their healthiest. We offer flexible group insurance plans for any size business. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. Prior authorizations are required for: All non-par providers. The resources for our providers may differ between states. National Accounts, Posts about using health Insurance and managing your health, Collections of learning resources and links to services, For Sydney Health users connect with others and find care programs. 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. 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. 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. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. 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") You can also visit bcbs.com to find resources for other states. Additional medical policies may be developed from time to time and some may be withdrawn from use. Reimbursement Policies. Enter a CPT or HCPCS code in the space below. In Indiana: Anthem Insurance Companies, 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. Our resources vary by state. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. Inpatient services and nonparticipating providers always require prior authorization. Type at least three letters and well start finding suggestions for you. Inpatient services and non-participating providers always require prior authorization. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. We currently don't offer resources in your area, but you can select an option below to see information for that state. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) 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. It looks like you're in . You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed. You can also visit. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. Vaccination is important in fighting against infectious diseases. Find drug lists, pharmacy program information, and provider resources. Please verify benefit coverage prior to rendering services. You can also visit bcbs.com to find resources for other states. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Please verify benefit coverage prior to rendering services. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. In Kentucky: Anthem Health Plans of Kentucky, Inc. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association.