Your dashboard may experience future loading problems if not resolved. Prior authorizations are required for: All non-par providers. You can access the Precertification Lookup Tool through the Availity Portal. 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. We look forward to working with you to provide quality service for our members. If you arent registered to use Availity, signing up is easy and 100% secure. Additional medical policies may be developed from time to time and some may be withdrawn from use. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. Members should contact their local customer service representative for specific coverage information. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. 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. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans 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. Available for iOS and Android devices. Interested in joining our provider network? Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. 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. Choose your location to get started. Select Auth/Referral Inquiry or Authorizations. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. If your state isn't listed, check out bcbs.com to find coverage in your area. Price a medication, find a pharmacy,order auto refills, and more. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Choose your state below so that we can provide you with the most relevant information. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. 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). Find answers to all your questions with an Anthem representative in real time. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. There is no cost for our providers to register or to use any of the digital applications. 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 currently don't offer resources in your area, but you can select an option below to see information for that state. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Here you'll find information on the available plans and their benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. We currently don't offer resources in your area, but you can select an option below to see information for that state. Your dashboard may experience future loading problems if not resolved. Anthem offers great healthcare options for federal employees and their families. Independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. These documents are available to you as a reference when interpreting claim decisions. 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. You must log in or register to reply here. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Type at least three letters and we will start finding suggestions for you. It looks like you're in . Where is the Precertification Lookup Tool located on Availity? Out-of-state providers. Make your mental health a priority. There are several factors that impact whether a service or procedure is covered under a members benefit plan. In Kentucky: Anthem Health Plans of Kentucky, Inc. We look forward to working with you to provide quality services to our members. Use of the Anthem websites constitutes your agreement with our Terms of Use. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Lets make healthy happen. 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. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. 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. The resources for our providers may differ between states. This tool is for outpatient services only. In Maine: Anthem Health Plans of Maine, Inc. 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. Health equity means that everyone has the chance to be their healthiest. Click Submit. 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. 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. After hours, verify member eligibility by calling the 24/7 NurseLine at. 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 look forward to working with you to provide quality services to our members. It looks like you're in . The tool will tell you if that service needs . Choose your location to get started. 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. Please update your browser if the service fails to run our website. Review medical and pharmacy benefits for up to three years. To stay covered, Medicaid members will need to take action. Find a Medicare plan that fits your healthcare needs and your budget. The resources for our providers may differ between states. 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. 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 noncovered services (in other words, experimental procedures, cosmetic surgery, etc. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. 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. Your browser is not supported. We look forward to working with you to provide quality service for our members. The medical policies do not constitute medical advice or medical care. Access your member ID card from our website or mobile app. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. Or Audit reveals crisis standards of care fell short during pandemic. We look forward to working with you to provide quality service for our members. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. For a better experience, please enable JavaScript in your browser before proceeding. Jan 1, 2020 In Indiana: Anthem Insurance Companies, Inc. 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. 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. Please Select Your State The resources on this page are specific to your state. 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. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Please verify benefit coverage prior to rendering services. A group NPI cannot be used as ordering NPI on a Medicare claim. In Kentucky: Anthem Health Plans of Kentucky, Inc. We offer flexible group insurance plans for any size business. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Our resources vary by state. 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. Find drug lists, pharmacy program information, and provider resources. 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") The notices state an overpayment exists and Anthem is requesting a refund. Please verify benefit coverage prior to rendering services. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. 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. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Inpatient services and nonparticipating providers always require prior authorization. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. No provider of outpatient services gets paid without reporting the proper CPT codes. We want to help physicians, facilities and other health care professionals submit claims accurately. Please update your browser if the service fails to run our website. 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. We are also licensed to use MCG guidelines to guide utilization management decisions. Choose your location to get started. 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. State & Federal / Medicaid. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). You can also visit bcbs.com to find resources for other states. Understand your care options ahead of time so you can save time and money. Your browser is not supported. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Inpatient services and non-participating providers always require prior authorization. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. In Ohio: Community Insurance Company. Access to the information does not require an Availity role assignment, tax ID or NPI. Explore our resources. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Call our Customer Service number, (TTY: 711). Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. Apr 1, 2022 Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. 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. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. Please verify benefit coverage prior to rendering services. With Codify by AAPC cross-reference tools, you can check common code pairings. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). In Maine: Anthem Health Plans of Maine, Inc. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Youll also strengthen your appeals with access to quarterly versions since 2011. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. We currently don't offer resources in your area, but you can select an option below to see information for that state. You can also visit bcbs.com to find resources for other states. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). New member? Find drug lists, pharmacy program information, and provider resources. 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. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Please verify benefit coverage prior to rendering services. 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. For subsequent inpatient care, see 99231-99233. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. 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. 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. Independent licensees of the Blue Cross and Blue Shield Association. New member? It looks like you're outside the United States. Our resources vary by state. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Provider Medical Policies | Anthem.com Find information that's tailored 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. 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. Vaccination is important in fighting against infectious diseases. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Medicare Complaints, Grievances & Appeals. 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 Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Please note: This tool is for outpatient services only. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. 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. Copyright 2023. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. Compare plans available in your area and apply today. Taking time for routine mammograms is an important part of staying healthy. Inpatient services and nonparticipating providers always require prior authorization. To get started, select the state you live in. The resources for our providers may differ between states. It does not reflect benefits coverage, nor does it include an exhaustive listing of all non-covered services (in other words, experimental procedures, cosmetic surgery, etc.). Contact will be made by an insurance agent or insurance company. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. 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.