Administrative / Digital Tools, Learn more by attending this live webinar. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. State & Federal / Medicaid. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. You can also visit bcbs.com to find resources for other states. A group NPI cannot be used as ordering NPI on a Medicare claim. 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 also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). Type at least three letters and well start finding suggestions for you. 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. Please note: This tool is for outpatient services only. In Maine: Anthem Health Plans of Maine, Inc. Start a Live Chat with one of our knowledgeable representatives. We currently don't offer resources in your area, but you can select an option below to see information for that state. JavaScript is disabled. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. In Connecticut: Anthem Health Plans, Inc. Taking time for routine mammograms is an important part of staying healthy. We look forward to working with you to provide quality service for our members. 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 Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Copyright 2023. 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. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. 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. 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. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. Our call to Anthem resulted in a general statement basically use a different code. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. Not connected with or endorsed by the U.S. Government or the federal Medicare program. 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. 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). We want to help physicians, facilities and other health care professionals submit claims accurately. Contact will be made by an insurance agent or insurance company. 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. Our resources vary by state. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. These guidelines do not constitute medical advice or medical care. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Inpatient services and nonparticipating providers always require prior authorization. Choose your state below so that we can provide you with the most relevant information. Choose your location to get started. Members should discuss the information in the medical policies with their treating health care professionals. 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. Additional medical policies may be developed from time to time and some may be withdrawn from use. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Members should contact their local customer service representative for specific coverage information. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. Health equity means that everyone has the chance to be their healthiest. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. It looks like you're in . As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. If youre concerned about losing coverage, we can connect you to the right options for you and your family. You can access the Precertification Lookup Tool through the Availity Portal. No provider of outpatient services gets paid without reporting the proper CPT codes. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Find a Medicare plan that fits your healthcare needs and your budget. Please update your browser if the service fails to run our website. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. Prior authorizations are required for: All non-par providers. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Apr 1, 2022 As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Use the Prior Authorization tool within Availity. Enter one or more keyword (s) for desired policy or topic. 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). The resources for our providers may differ between states. The resources for our providers may differ between states. New member? Explore our resources. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. Call our Customer Service number, (TTY: 711). 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. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Use of the Anthem websites constitutes your agreement with our Terms of Use. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Reimbursement Policies. The resources on this page are specific to your state. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Find out if a service needs prior authorization. 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. Prior Authorization Lookup. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Choose your location to get started. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. For costs and complete details of the coverage, please contact your agent or the health plan. Jan 1, 2020 Lets make healthy happen. Medical policies can be highly technical and complex and are provided here for informational purposes. To get started, select the state you live in. Inpatient services and nonparticipating providers always require prior authorization. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. 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. The purpose of this communication is the solicitation of insurance. They are not agents or employees of the Plan. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Select Your State There are several factors that impact whether a service or procedure is covered under a members benefit plan. We look forward to working with you to provide quality service for our members. Use of the Anthem websites constitutes your agreement with our Terms of Use. We offer affordable health, dental, and vision coverage to fit your budget. It looks like you're outside the United States. 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. Independent licensees of the Blue Cross Association. Enter a Current Procedural Terminology (CPT) code in the space below to get started. We are also licensed to use MCG guidelines to guide utilization management decisions. 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). The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. These documents are available to you as a reference when interpreting claim decisions. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. Understand your care options ahead of time so you can save time and money. Compare plans available in your area and apply today. Access resources to help health care professionals do what they do bestcare for our members. 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. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. 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. Choose your state below so that we can provide you with the most relevant information. It looks like you're outside the United States. 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. 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. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Select Auth/Referral Inquiry or Authorizations. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. This tool is for outpatient services only. 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. 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. They are not agents or employees of the Plan. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Inpatient services and non-participating providers always require prior authorization. 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. 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. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. 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. 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. Medicaid renewals will start again soon. Please update your browser if the service fails to run our website. ET. 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. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Were committed to supporting you in providing quality care and services to the members in our network. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Please Select Your State The resources on this page are specific to your state. In Indiana: Anthem Insurance Companies, Inc. Choose your state below so that we can provide you with the most relevant information. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Prior authorization lookup tool| HealthKeepers, Inc. Do not sell or share my personal information. Vaccination is important in fighting against infectious diseases. Please verify benefit coverage prior to rendering services. If your state isn't listed, check out bcbs.com to find coverage in your area. New member? 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. Access your member ID card from our website or mobile app. It looks like you're in . For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. You can also visit. There is no cost for our providers to register or to use any of the digital applications. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. Interested in joining our provider network? 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. 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.) We update the Code List to conform to the most recent publications of CPT and HCPCS . Audit reveals crisis standards of care fell short during pandemic. Large Group Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. 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. In Indiana: Anthem Insurance Companies, Inc. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. You must log in or register to reply here. Directions. Review medical and pharmacy benefits for up to three years. 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. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued.