anthem blue cross prior authorization list

Log into the Members portal to view the status of your prior authorization under the Claims &Eligibility menu. Independent licensees of the Blue Cross and Blue Shield Association. You can also refer to the provider manual for information about services that require prior authorization. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. Prior authorization is required for surgical services only. Check whether a prior authorization is needed Check the status of a prior authorization This information is also available in other ways to people with disabilities by calling customer service at (651) 662-8000 (voice), or 1-800-382-2000 (toll free). Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. The CarelonRx member services telephone number is 833-279-0458. Use these lists to identify the member services that require prior authorization. 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. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. | Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. We currently don't offer resources in your area, but you can select an option below to see information for that state. Your plan has a list of services that require prior authorization. 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. 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. URAC Accredited - Health Plan with Health Insurance Marketplace (HIM) - 7.3, URAC Accredited - Health Utilization Management - 7.4, Member forms - Individual and family plans, Coverage policy and pre-certification/pre-authorization, Approval information for radiological services, Medicare Advantage Prior Authorization Request Form, Part B Medication Prior Approval Request Form, Check deductible and out-of-pocket totals. State & Federal / Medicare. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. FEP Basic Option/Standard OptionFEP Blue Focus. Oromoo | We deliver personalized healthcare the way you want it, where you need it: in our neighborhood Care Centers, in your own home, in hospitals or skilled nursing facilities. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. The resources for our providers may differ between states. We look forward to working with you to provide quality services to our members. Anthem is a registered trademark of Anthem Insurance Companies, Inc. With convenience in mind, Care Centers are at the heart of the patient health journey. benefit certificate to determine which services need prior approval. Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan. Prior Authorization details for providers outside of WA/AK. In Maine: Anthem Health Plans of Maine, Inc. Contact 866-773-2884 for authorization regarding treatment. Have you reviewed your online provider directory information lately? 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 service for our members. March 2023 Anthem Provider News - New Hampshire. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). 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 In Ohio: Community Insurance Company. | | Some procedures may also receive instant approval. In the case of an emergency, you do not need prior authorization. Use Availity to submit prior authorizations and check codes. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. 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. 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Oct 1, 2020 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. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. More prior authorization resources Sign in to Availity 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. Step 1 At the top of the form, supply the plan/medical group name, plan/medical group phone number, and plan/medical group fax number. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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 were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. You are invited: Advancing Mental Health Equity for Youth & Young Adults. Important: Blueprint Portal will not load if you are using Internet Explorer. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Use of the Anthem websites constitutes your agreement with our Terms of Use. P | Complete all member information fields on this form: Complete either the denial or the termination information section. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. Updated June 02, 2022. 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). State & Federal / Medicare. may be offered to you through such other websites or by the owner or operator of such other websites. or operation of any other website to which you may link from this website. the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible If you receive services that are not medically necessary from one of Blue Cross of Idahos contracting providers without getting prior authorization and payment for the services is denied, you are not financially responsible. You understand and agree that by making any There is a list of these services in your member contract. Anthem is a registered trademark of Anthem Insurance Companies, Inc. In Indiana: Anthem Insurance Companies, Inc. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. Franais | of all such websites. We currently don't offer resources in your area, but you can select an option below to see information for that state. Step 9 At the top of page 2, provide the patients name and ID number. 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. Blueprint Portal is a members-only website that will help you understand and manage your health plan so youre able to find quality, patient-focused healthcare at the best possible price. Medical and Behavioral Health Procedure Codes Requiring Prior Authorization: Providers please note that as of the 2/1/2022 Prior Authorization release, we are moving to one document that includes authorization requirements for Medical, Durable Medical Equipment, eviCore, and Behavioral Health rather than individual documents for each specialty. It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. Availity is solely responsible for its products and services. Use of the Anthem websites constitutes your agreement with our Terms of Use. Use of the Anthem websites constitutes your agreement with our Terms of Use. An Independent Licensee of the Blue Cross and Blue Shield Association, Summary of Benefits & Coverage Information, Sleep Testing and Therapy & Advanced Imaging, Confirm your specific treatment plan and medical necessity given your diagnosis, Determine if services are eligible for coverage, Assure your claims are processed accurately and timely, Save you from unnecessary medical expenses. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Electronic authorizations. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 2022 Electronic Forms LLC. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). FEP utilizes Magellan Rx Management for medical, Providers requesting prior approval for an ASE/PSE member should use the appropriate form on the, Providers who are requesting a prior approval for Walmart or other BlueAdvantage members should use the appropriate form from the, Providers who are requesting a prior approval for BlueMedicare or Health Advantage Medicare Advantage members should use the appropriate form from, Providers requesting prior approval for Part B drugs for BlueMedicare or Health Advantage Medicare should use the, Name and telephone number of contact person, Requesting / Performing Providers NPI or Provider ID, Copy of members insurance card (front/back), CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable, Please use the most descriptive procedure and diagnosis codes, Medical records to support requested services. Visit Anthem.com to learn more about how we coordinate our medical and pharmacy benefits, review our drug lists, submit prior authorization requests, and more. A new prior In the case of a medical emergency, you do not need prior authorization to receive care. 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. | Our electronic prior authorization (ePA) process is the preferred method for . By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. By filling out the form completely and with as much information as possible, you can be sure we have the information to process your request timely. 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. 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. link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. Please verify benefit coverage prior to rendering services. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. The formcontains important information regarding the patients medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patients health care plan. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Ting Vit | Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Anthem is a registered trademark of Anthem Insurance Companies, Inc. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. Information about COVID-19 and your insurance coverage. others in any way for your decision to link to such other websites. In some cases, we require more information and will request additional records so we can make a fully informed decision. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Polski | Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Noncompliance with new requirements may result in denied claims. We currently don't offer resources in your area, but you can select an option below to see information for that state. Please update your browser if the service fails to run our website. 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. View requirements for Basic Option, Standard Option and FEP Blue Focus. You can also visit, Standard Local Prior Authorization Code List, Standard Prior Authorization Requirements, SHBP Precertification Procedure Codes Sheet, SHBP Co-pay/Co-insurance Waiver Medication List. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Find care, claims & more with our new app. Get Started The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Access eligibility and benefits information on the Availity Web Portal or Use the Prior Authorization Lookup Tool within Availity or Contact the Customer Care Center: Outside Los Angeles County: 1-800-407-4627 Inside Los Angeles County: 1-888-285-7801 Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. In Kentucky: Anthem Health Plans of Kentucky, Inc. Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. March 2023 Anthem Provider News - New Hampshire, February 2023 Provider Newsletter - New Hampshire, Telephonic-only care allowance extended through April 11, 2023 - New Hampshire, January 2023 Provider Newsletter - New Hampshire, Reimbursement for services by clinical behavioral health providers seeking licensure, Time to prepare for HEDIS medical record review, New policy for EMR clinical data sharing and ADT notifications, Reimbursement policy update: Modifiers 25 and 57 - Professional, Specialty pharmacy updates for March 2023, Clinical Criteria updates for specialty pharmacy. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. Your browser is not supported. No, the need for emergency services does not require prior authorization. | This may result in a delay of our determination response. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. View medication policies and pre-authorization requirements. They may request or review medical records, test results and other information so they understand what services are being performed and are able to make an informed decision. Inpatient services and nonparticipating providers always require prior authorization. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. 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. Learn more about electronic authorization. The Blue Cross name and symbol are registered marks of the Blue Cross Association. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. In Connecticut: Anthem Health Plans, Inc. Italiano | Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Let us know! third-party website link available as an option to you, ABCBS does not in any way endorse any such website, Out-of-area providers We're here to work with you, your doctor and the facility so you have the best possible health outcome. In Kentucky: Anthem Health Plans of Kentucky, Inc. Prior approval for requested services - Arkansas Blue Cross and Blue Shield Prior approval for requested services The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Sign in to the appropriate website to complete your request. Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, Select Auth/Referral Inquiry or Authorizations. All rights reserved. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Stay Covered When Medicaid Renewals Begin Medicaid renewals will start again soon. Non-individual members Use Availity to submit prior authorizations and check codes. ), 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation, 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach, 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach, 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach, 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy), 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis, 33419 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure), 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed, 33979 Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle, 33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only, 36514 Therapeutic Apheresis; Plasma Pheresis, 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection, 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed, A4224 Supplies for maintenance of insulin infusion catheter, per week, A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each, A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe, A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fah, A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each, A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries, C1722 Cardioverter-defibrillator, single chamber (implantable), L5671 Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert, L5673 Addition to lower extremity, below knee/above knee, custom fabricated, L5679 Addition to lower extremity, below knee/above knee, custom fabricated, L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature, L5981 All lower extremity prostheses, flex-walk system or equal, L5987 All lower extremity prostheses, shank foot system with vertical loading pylon, L8699 Prosthetic implant, not otherwise specified, L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code.

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