We currently don't offer resources in your area, but you can select an option below to see information for that state. Plus, you may qualify for financial help to lower your health coverage costs. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Select Your State In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. You can access the Precertification Lookup Tool through the Availity Portal. 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 service for our members. Explore our resources. 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. 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. Understand your care options ahead of time so you can save time and money. Access to the information does not require an Availity role assignment, tax ID or NPI. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. State & Federal / Medicaid. Our resources vary by state. In Kentucky: Anthem Health Plans of Kentucky, Inc. Please note that services listed as requiring precertification may not be covered benefits for a member. For costs and complete details of the coverage, please contact your agent or the health plan. Please update your browser if the service fails to run our website. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. 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. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. 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. We update the Code List to conform to the most recent publications of CPT and HCPCS . 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. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. E0731 Conductive garment for Tens 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 These guidelines do not constitute medical advice or medical care. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. There is no cost for our providers to register or to use any of the digital applications. Please verify benefit coverage prior to rendering services. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. We currently don't offer resources in your area, but you can select an option below to see information for that state. The resources for our providers may differ between states. The resources on this page are specific to your state. Members should discuss the information in the medical policies with their treating health care professionals. 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. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. Contact will be made by an insurance agent or insurance company. Use of the Anthem websites constitutes your agreement with our Terms of Use. Your dashboard may experience future loading problems if not resolved. 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. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Provider Medical Policies | Anthem.com Find information that's tailored for you. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). This tool is for outpatient services only. Type at least three letters and we will start finding suggestions for you. With Codify by AAPC cross-reference tools, you can check common code pairings. Your dashboard may experience future loading problems if not resolved. Reaching out to Anthem at least here on our. Provider Policies, Guidelines and Manuals | 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. Pay outstanding doctor bills and track online or in-person payments. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Review medical and pharmacy benefits for up to three years. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. If this is your first visit, be sure to check out the. Inpatient services and nonparticipating providers always require prior authorization. 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. In Connecticut: Anthem Health Plans, 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. It looks like you're outside the United States. The purpose of this communication is the solicitation of insurance. 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. 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 the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. 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. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. The resources for our providers may differ between states. Members should contact their local customer service representative for specific coverage information. Compare plans available in your area and apply today. We want to help physicians, facilities and other health care professionals submit claims accurately. Your dashboard may experience future loading problems if not resolved. Interested in joining our provider network? Inpatient services and nonparticipating providers always require prior authorization. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. Inpatient services and non-participating providers always require prior authorization. We currently don't offer resources in your area, but you can select an option below to see information for that state. They are not agents or employees of the Plan. There are several factors that impact whether a service or procedure is covered under a members benefit plan. Inpatient services and non-participating providers always require prior authorization. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. 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 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Click Submit. 711. Call our Customer Service number, (TTY: 711). ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Out-of-state providers. Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment, Indiana Medicaid Prior Authorization Requirements List, New Option Available for Indiana Market. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. 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. We look forward to working with you to provide quality services to our members. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Find out if a service needs prior authorization. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. We offer affordable health, dental, and vision coverage to fit your budget. Additional medical policies may be developed from time to time and some may be withdrawn from use. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Our resources vary by state. The tool will tell you if that service needs . 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. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Youll also strengthen your appeals with access to quarterly versions since 2011. You must log in or register to reply here. Vaccination is important in fighting against infectious diseases. Our resources vary by state. Medical policies can be highly technical and complex and are provided here for informational purposes. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. 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. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. These documents are available to you as a reference when interpreting claim decisions. Members should discuss the information in the clinical UM guideline with their treating health care providers. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. Jan 1, 2020 To stay covered, Medicaid members will need to take action. In Indiana: Anthem Insurance Companies, Inc. Quickly and easily submit out-of-network claims online. We are also licensed to use MCG guidelines to guide utilization management decisions. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. 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. Your browser is not supported. Select Auth/Referral Inquiry or Authorizations. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Prior authorization lookup tool| HealthKeepers, Inc. Use of the Anthem websites constitutes your agreement with our Terms of Use. You can also visit. In Maine: Anthem Health Plans of Maine, Inc. 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. It looks like you're in . ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Here you'll find information on the available plans and their benefits. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Administrative / Digital Tools, Learn more by attending this live webinar. 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. Copyright 2023. Health equity means that everyone has the chance to be their healthiest. 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. 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. We offer flexible group insurance plans for any size business. It looks like you're outside the United States. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. * Services may be listed as requiring precertification that may not be covered benefits for a particular member.