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. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. Choose your location to get started. Use the Prior Authorization tool within Availity OR. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Inpatient services and non-participating providers always require prior authorization. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Choose your location to get started. Please verify benefit coverage prior to rendering services. 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. No provider of outpatient services gets paid without reporting the proper CPT codes. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. For subsequent inpatient care, see 99231-99233. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. This tool is for outpatient services only. Choose your state below so that we can provide you with the most relevant information. JavaScript is disabled. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. Understand your care options ahead of time so you can save time and money. Vaccination is important in fighting against infectious diseases. 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. The resources on this page are specific to your state. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. 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. Out-of-state providers. The medical policies do not constitute medical advice or medical care. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. You can also visit bcbs.com to find resources for other states. 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. 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. 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 Connecticut: Anthem Health Plans, Inc. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. 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. 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. Call Provider Services at 1-800-454-3730 (TTY 711) After hours, verify member eligibility by calling the 24/7 Nurse HelpLine at 1-800-600-4441. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. 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. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. In Connecticut: Anthem Health Plans, Inc. You must log in or register to reply here. Type at least three letters and we will start finding suggestions for 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. 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. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Prior authorization lookup tool| HealthKeepers, Inc. Large Group Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. The resources for our providers may differ between states. Make your mental health a priority. Were committed to supporting you in providing quality care and services to the members in our network. We are also licensed to use MCG guidelines to guide utilization management decisions. 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. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. Our resources vary by state. Members should discuss the information in the medical policies with their treating health care professionals. Enter a CPT or HCPCS code in the space below. We offer flexible group insurance plans for any size business. Choose your state below so that we can provide you with the most relevant information. 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 your state isn't listed, check out bcbs.com to find coverage in your area. Reimbursement Policies. Members should contact their local customer service representative for specific coverage information. Access resources to help health care professionals do what they do bestcare for our members. 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. Independent licensees of the Blue Cross and Blue Shield Association. 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. Available for iOS and Android devices. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. It looks like you're in . Find a Medicare plan that fits your healthcare needs and your budget. Your browser is not supported. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. To get started, select the state you live in. Quickly and easily submit out-of-network claims online. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Apr 1, 2022 It looks like you're outside the United States. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans All other available Medical Policy documents are published by policy/topic title. 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.) While the clinical UM guidelines developed by us are published on this web site, the licensed standard and customized MCG guidelines are proprietary to MCG and are not published on the Internet site. Directions. Interested in joining our provider network? Our resources vary by state. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 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 resources for our providers may differ between states. It looks like you're in . We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. We currently don't offer resources in your area, but you can select an option below to see information for that state. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. Choose your location to get started. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. 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. 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. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. 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. Use our app, Sydney Health, to start a Live Chat. 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. In Kentucky: Anthem Health Plans of Kentucky, Inc. We currently don't offer resources in your area, but you can select an option below to see information for that state. Compare plans available in your area and apply today. Jan 1, 2020 * Services may be listed as requiring precertification that may not be covered benefits for a particular member.

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