This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Please Select Your State The resources on this page are specific to your state. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Other ways to access: If you are currently accessing the Pre-certification / Pre-Authorization Requirements list through your health plans public website, this option is still available for you. Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Your dashboard may experience future loading problems if not resolved. In Indiana: Anthem Insurance Companies, Inc. It looks like you're outside the United States. The resources for our providers may differ between states. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Provider Medical Policies | Anthem.com The resources on this page are specific to your state. Use our app, Sydney Health, to start a Live Chat. 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. It looks like you're outside the United States. Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. Find drug lists, pharmacy program information, and provider resources. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. 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 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. Choose your state below so that we can provide you with the most relevant information. No provider of outpatient services gets paid without reporting the proper CPT codes. Provider Medical Policies | Anthem.com Find information that's tailored for you. We currently don't offer resources in your area, but you can select an option below to see information for that state. Please verify benefit coverage prior to rendering services. 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. 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. Please verify benefit coverage prior to rendering services. The purpose of this communication is the solicitation of insurance. Health Benefits for Federal Employees | Anthem Members should contact their local customer service representative for specific coverage information. Health equity means that everyone has the chance to be their healthiest. Understand your care options ahead of time so you can save time and money. Medicaid renewals will start again soon. Use the Prior Authorization tool within Availity. Your browser is not supported. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services Please update your browser if the service fails to run our website. Independent licensees of the Blue Cross and Blue Shield Association. Prior authorization lookup tool | NY Provider - Empire Blue Cross Access your member ID card from our website or mobile app. 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. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. The tool will tell you if that service needs . You can access the Precertification Lookup Tool through the Availity Portal. ET. Select Auth/Referral Inquiry or Authorizations. Available for iOS and Android devices. 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. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. A group NPI cannot be used as ordering NPI on a Medicare claim. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Explore programs available in your state. We currently don't offer resources in your area, but you can select an option below to see information for that state. Please update your browser if the service fails to run our website. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Our resources vary by state. Self-Service Tools Or Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. 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. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). 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. You can also visit bcbs.com to find resources for other states. 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. 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. Members should discuss the information in the medical policies with their treating health care professionals. 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. Prior Authorization Code Lookup Inpatient services and nonparticipating providers always require prior authorization. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Copyright 2023. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. Click Submit. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. 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. With Codify by AAPC cross-reference tools, you can check common code pairings. Anthem offers great healthcare options for federal employees and their families. Enter one or more keyword (s) for desired policy or topic. For Providers: Medical Policy and Pre-Cert/Pre-Auth Router - BCBSM Independent licensees of the Blue Cross and Blue Shield Association. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. We currently don't offer resources in your area, but you can select an option below to see information for that state. You must log in or register to reply here. Please verify benefit coverage prior to rendering services. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Member benefit lookup by procedure code - Anthem There is no cost for our providers to register or to use any of the digital applications. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. Inpatient services and non-participating providers always require prior authorization. The resources for our providers may differ between states. Find answers to all your questions with an Anthem representative in real time. Medical policies can be highly technical and complex and are provided here for informational purposes. We look forward to working with you to provide quality service for our members. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. If you arent registered to use Availity, signing up is easy and 100% secure. Price a medication, find a pharmacy,order auto refills, and more. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. In Maine: Anthem Health Plans of Maine, Inc. Our research shows that subscribers using Codify by AAPC are 33% more productive. We offer flexible group insurance plans for any size business. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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.
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