We look forward to working with you to provide quality services to our members. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Inpatient services and nonparticipating providers always require prior authorization. They are not agents or employees of the Plan. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Please Select Your State The resources on this page are specific to your state. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. The resources on this page are specific to your state. Enter a CPT or HCPCS code in the space below. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. 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. For costs and complete details of the coverage, please contact your agent or the health plan. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. You can also visit. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Contact will be made by an insurance agent or insurance company. Find answers to all your questions with an Anthem representative in real time. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Members should discuss the information in the clinical UM guideline with their treating health care providers. This tool is for outpatient services only. Choose your state below so that we can provide you with the most relevant information. Review medical and pharmacy benefits for up to three years. Youll also strengthen your appeals with access to quarterly versions since 2011. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Please update your browser if the service fails to run our website. We currently don't offer resources in your area, but you can select an option below to see information for that state. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. 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. Do not sell or share my personal information. If your state isn't listed, check out bcbs.com to find coverage in your area. There are several factors that impact whether a service or procedure is covered under a members benefit plan. Please verify benefit coverage prior to rendering services. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Provider Medical Policies | Anthem.com Find information that's tailored for you. With Codify by AAPC cross-reference tools, you can check common code pairings. Price a medication, find a pharmacy,order auto refills, and more. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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. 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. 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 were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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). There is no cost for our providers to register or to use any of the digital applications. 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. Your online account is a powerful tool for managing every aspect of your health insurance plan. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. The purpose of this communication is the solicitation of insurance. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Select Auth/Referral Inquiry or Authorizations. Call our Customer Service number, (TTY: 711). The tool will tell you if that service needs . Use of the Anthem websites constitutes your agreement with our Terms of Use. Medicare Complaints, Grievances & Appeals. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. Make your mental health a priority. All other available Medical Policy documents are published by policy/topic title. Medicaid renewals will start again soon. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. To get started, select the state you live in. We offer flexible group insurance plans for any size business. Medical policies can be highly technical and complex and are provided here for informational purposes. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Enter a Current Procedural Terminology (CPT) code in the space below to get started. 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. This tool is for outpatient services only. Were committed to supporting you in providing quality care and services to the members in our network. Your dashboard may experience future loading problems if not resolved. Inpatient services and non-participating providers always require prior authorization. In Connecticut: Anthem Health Plans, Inc. 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. We want to help physicians, facilities and other health care professionals submit claims accurately. 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. 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. Find drug lists, pharmacy program information, and provider resources. If youre concerned about losing coverage, we can connect you to the right options for you and your family. In Maine: Anthem Health Plans of Maine, Inc. 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. It may not display this or other websites correctly. Inpatient services and non-participating providers always require prior authorization. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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 were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Or The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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 It looks like you're outside the United States. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. 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. Use the Prior Authorization tool within Availity OR. 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. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Directions. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. We look forward to working with you to provide quality service for our members. 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. Access eligibility and benefits information on the Availity* Portal OR. 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. 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. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. 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") 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. Type at least three letters and well start finding suggestions for you. Please note that services listed as requiring precertification may not be covered benefits for a member. 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. Our resources vary by state. The resources for our providers may differ between states. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. We look forward to working with you to provide quality services to our members. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Administrative / Digital Tools, Learn more by attending this live webinar. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Use of the Anthem websites constitutes your agreement with our Terms of Use. Members should contact their local customer service representative for specific coverage information. 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. JavaScript is disabled. 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. 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. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. Vaccination is important in fighting against infectious diseases. Anthem offers great healthcare options for federal employees and their families. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). Use the Prior Authorization tool within Availity. The notices state an overpayment exists and Anthem is requesting a refund. We currently don't offer resources in your area, but you can select an option below to see information for that state. Click Submit. Out-of-state providers. Interested in joining our provider network? 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. 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. 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. 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. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. They are not agents or employees of the Plan. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Quickly and easily submit out-of-network claims online. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. In Maine: Anthem Health Plans of Maine, Inc. Your browser is not supported. 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. If this is your first visit, be sure to check out the. If your state isn't listed, check out bcbs.com to find coverage in your area. Find drug lists, pharmacy program information, and provider resources. 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. Large Group 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. Your browser is not supported. Understand your care options ahead of time so you can save time and money. Choose your location to get started. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Here you'll find information on the available plans and their benefits. We currently don't offer resources in your area, but you can select an option below to see information for that state. Reimbursement Policies. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. 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. 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. Please update your browser if the service fails to run our website. 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. Our resources vary by state. 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 Indiana: Anthem Insurance Companies, Inc. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. It looks like you're outside the United States. Access to the information does not require an Availity role assignment, tax ID or NPI. We look forward to working with you to provide quality service for our members. Understand your care options ahead of time so you can save time and money. Find out if a service needs prior authorization. The resources for our providers may differ between states. 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. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. We are also licensed to use MCG guidelines to guide utilization management decisions. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Select Your State 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.
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