AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Scroll down to the table of contents. Medicare Coverage with Anthem Medicare Information Medicare Coverage and Enrollment Turning 65 Medicare Advantage Plans: Part C Medicare Part D Plans Medicare Supplement Plans (Medigap) Dental and Vision Coverage CareCare What to Know Getting Better Care Preventive Health Find Care Medicare Caregiver Resources SupportSupport Login Registration Independent licensees of the Blue Cross and Blue Shield Association. Providers should continue to verify member eligibility and benefits prior to rendering services. The services marked with an asterisk (*) only require Pre-Service Review for members enrolled in BlueChoice products if performed in an outpatient setting that is on the campus of a hospital. Noncompliance with new requirements may result in denied claims. This approval process is called prior authorization. These manuals are your source for important information about our policies and procedures. This approval process is called prior authorization. In the event of an emergency, members may access emergency services 24/7. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). 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. %%EOF Decide on what kind of signature to create. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. The purpose of this communication is the solicitation of insurance. Please verify benefit coverage prior to rendering services. (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. Start by choosing your patient's network listed below. 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. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. endstream endobj 452 0 obj <. You can also check status of an existing request and auto-authorize more than 40 common procedures. Information to help you maximize your performance in our quality programs. BCBS FEP Vision covers frames, lenses, and eye exams. CoverKids. Select Auth/Referral Inquiry or Authorizations. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Code Bundling Rationale 2017 Q3 CPT Codes, Code Bundling Rationale 2017 Q2CPT Codes, Code Bundling Rationale 2017 Q1CPT Codes, Code Bundling Rationale 2016 Q4CPT Codes, Code Bundling Rationale 2016 Q3CPT Codes, Code Bundling Rationale 2016 Q2CPT Codes, Code Bundling Rationale 2016 Q1CPT Codes, Code Bundling Rationale 2015 Q4CPT Codes, Code Bundling Rationale 2015 Q3CPT Codes, Code Bundling Rationale 2015 Q2CPT Codes, Code Bundling Rationale 2015 Q1CPT Codes, Code Bundling Rationale 2014 Q4CPT Codes, Code Bundling Rationale 2014 Q3CPT Codes, Code Bundling Rationale 2014 Q2CPT Codes, Code Bundling Rationale 2014 Q1CPT Codes, Code Bundling Rationale 2013 Q4CPT Codes, Code Bundling Rationale 2013 Q3CPT Codes, Code Bundling Rationale 2013 Q2CPT Codes, Code Bundling Rationale 2013 Q1CPT Codes, Code Bundling Rationale 2012 Q4CPT Codes, Code Bundling Rationale 2012 Q3CPT Codes, Code Bundling Rationale 2012 Q2CPT Codes, Code Bundling Rationale 2012 Q1CPT Codes, Code Bundling Rationale 2011 Q4CPT Codes, Code Bundling Rationale 2011 Q3CPT Codes, Code Bundling Rationale 2011 Q2CPT Codes, Code Bundling Rationale 2011 Q1CPT Codes, Code Bundling Rationale 2010 Q4CPT Codes, Code Bundling Rationale 2010 Q3CPT Codes, Code Bundling Rationale 2010 Q2CPT Codes, Code Bundling Rationale 2010 Q1CPT Codes, 1998-document.write(new Date().getFullYear()); BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 CareFirst reserves the right to change this list at any time without notice. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Select Patient Registration from the top navigation. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. State & Federal / Medicare. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Musculoskeletal (eviCore): 800-540-2406. 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. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Choose My Signature. Please refer to the criteria listed below for genetic testing. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Do not sell or share my personal information. The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. External link You are leaving this website/app (site). Long-Term Care (LTC) Forms. In Indiana: Anthem Insurance Companies, Inc. Not connected with or endorsed by the U.S. Government or the federal Medicare program. 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. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. This includes our Medicaid Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM(MA PPO) members. 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. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services (CMS) guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. CareFirst Commercial Pre-Service Review and Prior Authorization. Summaries and code lists are posted as a reference to help you determine when prior authorization may be required for non-HMO government programs members. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items Review Choice Demonstration for Home Health Services Return to Top In Virginia, CareFirst MedPlus and CareFirst Diversified Benefits are is the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. You'll also find news and updates for all lines of business. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. In 2020, Part B step therapy may apply to some categories . Updated June 02, 2022. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Expedited fax: 888-235-8390. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. We also support our providers with access to information about our plans and member benefits, news and updates, training materials and guides and other helpful resources. In Connecticut: Anthem Health Plans, Inc. PPO outpatient services do not require Pre-Service Review. In Maine: Anthem Health Plans of Maine, Inc. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. The latest edition and archives of our monthly provider newsletter. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Look up common health coverage and medical terms. . Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). In addition, some sites may require you to agree to their terms of use and privacy policy. endstream endobj startxref Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. These documents contain information about upcoming code edits. To get started, select the state you live in. 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. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Create your signature and click Ok. Press Done. Use of the Anthem websites constitutes your agreement with our Terms of Use. These documents contain information about your benefits, network and coverage. In Indiana: Anthem Insurance Companies, Inc. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Providers are responsible for verifying prior authorization requirements before services are rendered. For your convenience, we've put these commonly used documents together in one place. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. 494 0 obj <>stream Future updates regarding COVID-19 will appear in the monthly Provider News publication. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Get the latest news to help improve your life and keep you healthy. Electronic authorizations. Do not sell or share my personal information. FEP Medications requiring online prior authorization, Intravenous Immune Globulin (IVIG) Therapy, Stereotactic Radiosurgery Using Gamma Rays, Surprise Billing - Out-Of-Network Provider Notice, Ambulance -elective air transport only (10.0.005), Behavioral Health and Substance Use Disorder (Milliman Care Guidelines), Repetitive Transcranial Magnetic Stimulation (TMS), Inpatient Behavioral Health and Substance Use Disorder, Home health care (Criteria defined in the employer group benefit contract), Home Infusion Therapy (Criteria defined in the employer group benefit contract), Hospice (Criteria defined in the employer group benefit contract), Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care), Maternity Services- inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract), Out-of-network services (Benefits available according to the member contract), Private Duty Nursing (Criteria defined in the employer group benefit contract), Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care). The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Providers should call the prior authorization number on the back of the member ID card. One option is Adobe Reader which has a built-in reader. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Medicaid Behavioral/Physical Health Coordination. Forms and information about behavioral health services for your patients. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. In Connecticut: Anthem Health Plans, Inc. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Medicare Advantage. PPO outpatient services do not require Pre-Service Review. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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., 2022. Information about benefits for your patients covered by the BlueCard program. Pharmacy Forms. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. 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. 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 "Prior authorization list" is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. Bundling Rationale (Claims filed before Aug. 25, 2017). We look forward to working with you to provide quality services to our members. HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. Online - The AIM ProviderPortal is available 24x7. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. 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. Please refer to the criteria listed below for genetic testing. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Access the BH Provider Manuals, Rates and Resources webpage here. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. This new site may be offered by a vendor or an independent third party. Anthem does not require prior authorization for treatment of emergency medical conditions. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . 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. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Some procedures may also receive instant approval. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. To get started, select the state you live in. Type at least three letters and well start finding suggestions for you. 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