Here youll find information on the available plans and their benefits. Anthem offers great healthcare options for federal employees and their families. Nov 1, 2021 hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q Most PDF readers are a free download. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Providers should call the prior authorization number on the back of the member ID card. In Maine: Anthem Health Plans of Maine, Inc. In Connecticut: Anthem Health Plans, Inc. 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. In addition, some sites may require you to agree to their terms of use and privacy policy. In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. Type at least three letters and well start finding suggestions for you. Administrative. With three rich options to choose from, weve got you covered. 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. CareFirst Medicare Advantage requires notification/prior authorization of certain services. Start by choosing your patient's network listed below. 844-912-0938 Email: OhioMedicaidProvider@anthem.com Prior authorization resources and contact information Services Requiring Prior Authorization Inpatient prior authorization fax numbers Physical health: 877-643-0671 Behavioral health: 866-577-2184 Medicaid prior authorization: 800-964-3627 Outpatient prior authorization fax numbers Prior Authorization. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Any drugs, services, treatment, or supplies that the CareFirst medical staff determines, with appropriate consultation, to be experimental, investigational or unproven are not covered services. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Forms and information about behavioral health services for your patients. This step will help you determine if prior authorization may be required for a specific member and service. Type at least three letters and well start finding suggestions for you. Inpatient services and nonparticipating providers always require prior authorization. State & Federal / Medicare. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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 These manuals are your source for important information about our policies and procedures. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross name and symbol are registered marks of the Blue Cross Association. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. PPO outpatient services do not require Pre-Service Review. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Anthem HealthKeepers Plus Provider Manual, Long-term Services and Supports Authorization Guide. Call our Customer Service number, (TTY: 711). For more information, please refer to the Medical Policy Reference Manual. 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. You'll also find news and updates for all lines of business. The site may also contain non-Medicare related information. Anthem offers great healthcare options for federal employees and their families. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. 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. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Bundling Rationale (Claims filed before Aug. 25, 2017). 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. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. In 2020, Part B step therapy may apply to some categories . Please verify benefit coverage prior to rendering services. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. Providers should continue to verify member eligibility and benefits prior to rendering services. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. Forms and information about behavioral health services for your patients. %PDF-1.6 % This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. Commercial Prior Authorization Summary and Code Lists For your convenience, we've put these commonly used documents together in one place. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. In Indiana: Anthem Insurance Companies, Inc. The prior authorization information in this notice does not apply to requests for HMO members. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. 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 Ohio: Community Insurance Company. 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). 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. Inpatient Clinical: 800-416-9195. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. 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. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Medical Injectable Drugs: 833-581-1861. endstream endobj startxref endstream endobj 452 0 obj <. Access the BH Provider Manuals, Rates and Resources webpage here. Contact 866-773-2884 for authorization regarding treatment. Third-Party Liability (TPL) Forms. Decide on what kind of signature to create. BlueCross BlueShield of Tennessee uses a clinical editing database. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Please verify benefit coverage prior to rendering services. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Independent licensees of the Blue Cross Association. 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. 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). Updated June 02, 2022. CareFirst Commercial Pre-Service Review and Prior Authorization. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The clinical editing rationale supporting this database is provided here to assist you in understanding the Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. 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. Commercial. Provider Enrollment Forms. Use of the Anthem websites constitutes your agreement with our Terms of Use. Expedited fax: 888-235-8390. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. 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. This tool is for outpatient services only. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. One option is Adobe Reader which has a built-in reader. The purpose of this communication is the solicitation of insurance. 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. The following summaries and related prior authorization lists were posted on the Support Materials (Government Programs) page as of Jan. 1, 2021: Important Reminder: Check Eligibility and Benefits First * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. This approval process is called prior authorization. In the event of an emergency, members may access emergency services 24/7. rationale behind certain code pairs in the database. We look forward to working with you to provide quality service for our members. Providers should continue to verify member eligibility and benefits prior to rendering services. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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. 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 Effective 01/01/2023 (includes changes effective 04/01/2023) . . 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. February 2023 Anthem Provider News - Virginia, New ID cards for Anthem Blue Cross and Blue Shield members - Virginia, Telephonic-only care allowance extended through April 11, 2023 - Virginia, January 2023 Anthem Provider News - Virginia, December 2022 Anthem Provider News - Virginia, Medicare Advantage Providers | Anthem.com, March 2022 Anthem Provider News - Virginia, K1022 Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Medicare Advantage. Please refer to the criteria listed below for genetic testing. 477 0 obj <>/Filter/FlateDecode/ID[<530E5E682DBDAA468541E11BFAD96BAD>]/Index[451 44]/Info 450 0 R/Length 122/Prev 255106/Root 452 0 R/Size 495/Type/XRef/W[1 3 1]>>stream Prior authorization list. You may also view the prior approval information in the Service Benefit Plan Brochures. BCBS FEP Vision covers frames, lenses, and eye exams. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. 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. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. 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. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. 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. In Ohio: Community Insurance Company. 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. Details about new programs and changes to our procedures and guidelines. 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. Contact 866-773-2884 for authorization regarding treatment. 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. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Look up common health coverage and medical terms. Use of the Anthem websites constitutes your agreement with our Terms of Use. Prior Authorization for Some Commercial Members Will Transition from eviCore to AIM, Effective Jan. 1, 2021 This notice was posted Oct. 1, 2020, to alert you of a utilization management vendor change. For costs and complete details of the coverage, please contact your agent or the health plan. Online - The AIM ProviderPortal is available 24x7. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). In Kentucky: Anthem Health Plans of Kentucky, Inc. Availity provides administrative services to BCBSIL. CoverKids. Please refer to the criteria listed below for genetic testing. In Maine: Anthem Health Plans of Maine, Inc. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Rx Prior Authorization. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Independent licensees of the Blue Cross and Blue Shield Association. To learn more about required Colorado timelines for decisions regarding PA requests, please click, The Colorado Prescription Drug Prior Authorization Request form, The New Hampshire Prescription Drug Uniform Prior Authorization Request Form. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Do not sell or share my personal information. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). Anthem does not require prior authorization for treatment of emergency medical conditions. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. 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. Select Auth/Referral Inquiry or Authorizations. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Large Group 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Drug list/Formulary inclusion does not infer a drug is a covered benefit. It clarifies a utilization management vendor change for specific members. 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. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 451 0 obj <> endobj Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Forms and information to help you request prior authorization or file an appeal. Information about benefits for your patients covered by the BlueCard program. Information to help you maximize your performance in our quality programs. Pharmacy Forms. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. In Connecticut: Anthem Health Plans, 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., 2022. Noncompliance with new requirements may result in denied claims. Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. (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. In Indiana: Anthem Insurance Companies, Inc. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. 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. The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications We look forward to working with you to provide quality services to our members. Providers are responsible for verifying prior authorization requirements before services are rendered. Please use the We encourage providers to use Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Medical Clearance Forms and Certifications of Medical Necessity. 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