The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. There is a list of these services in your member contract. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Important: Blueprint Portal will not load if you are using Internet Explorer. Tagalog | Prior Authorization details for providers outside of WA/AK. of all such websites. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Have you reviewed your online provider directory information lately? Other Blue Plans pre-authorization requirements may differ from ours. This may result in a delay of our determination response. View requirements for group and Individual members on our commercial products. Log into the Members portal to view the status of your prior authorization under the Claims &Eligibility menu. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. We look forward to working with you to provide quality service for our 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. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Inpatient services and nonparticipating providers always require prior authorization. In Kentucky: Anthem Health Plans of Kentucky, Inc. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. PPO outpatient services do not require Pre-Service Review. Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department Step 5 In Medication / Medical and Dispensing Information, specify the medication name and indicate whether or not the request is a new therapy or a renewal (if renewal, specifythe date therapy started and the duration). This form should only be used for Arkansas Blue Cross and Blue Shield members. If you're concerned about losing coverage, we can connect you to the right options for you and your family. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Polski | Prior authorization is required for surgical services only. Espaol | Posted Jan. 11, 2021. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Franais | You further agree that ABCBS and its 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. others in any way for your decision to link to such other websites. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. Kreyl Ayisyen | Select Auth/Referral Inquiry or Authorizations. 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 This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. Your plan has a list of services that require prior authorization. Anthem partners with health care professionals to close gaps in care and improve members overall heath. 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 the case of a medical emergency, you do not need prior authorization to receive care. 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, o Massachusetts Collaborative Prior Authorization Form or o Blue Cross Blue Shield of Massachusetts Pre-certification Request Form Click on the title for complete list of drugs that require prior authorization: Medical Benefit Prior Authorization Medication List, #034 Medical Utilization Management and Pharmacy Prior Authorization, #033 March 2023 Anthem Provider News - Georgia, February 2023 Anthem Provider News - Georgia, New ID cards for Anthem Blue Cross and Blue Shield members - Georgia, Telephonic-only care allowance extended through April 11, 2023 - Georgia, January 2023 Anthem Provider News - Georgia, prior authorization/precertification form, September 2021 Anthem Provider News - Georgia. You understand and agree that by making any Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. 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. Prior authorization suspension for Anthem Ohio in-network hospital transfers to in-network skilled nursing facilities effective December 20, 2022 to January 15, 2023: Prior authorization suspension - In-network hospital transfers to In-network SNFs . CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. FEP Basic Option/Standard OptionFEP Blue Focus. 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. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. | Sep 1, 2021 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. | the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible 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. Register today for the Advancing Mental Health Equity for Youth & Young Adults forum hosted by Anthem Blue Cross and Blue Shield (Anthem) and Motivo* for Anthem providers on March 15, 2023. Prior to surgical treatment of gender dysphoria in FEP members, you must submit a treatment plan, including all surgeries planned, and the estimated date each will be performed. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. Looks like you're using an old browser. Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. View requirements for Basic Option, Standard Option and FEP Blue Focus. In Ohio: Community Insurance Company. Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. 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. Out-of-area providers We look forward to working with you to provide quality services to our members. 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. 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. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. February 2023 Anthem Provider News - Ohio, New ID cards for Anthem Blue Cross and Blue Shield members - Ohio, Telephonic-only care allowance extended through April 11, 2023 - Ohio, C1764 Event recorder, cardiac (implantable), E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized, E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, G0460 Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment, L3000 Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each, L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, L3170 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each, L3310 Lift, elevation, heel and sole, neoprene, per inch, L3332 Lift, elevation, inside shoe, tapered, up to one-half inch, L3580 Ortho shoe add instep Velcro closure, L3610 Transfer of an orthosis from one shoe to another, caliper plate, new, L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing, L3630 Transfer of an orthosis from one shoe to another, solid stirrup, new, L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified, L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf, L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf, L3761 Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf, L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf, L3807 Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise, L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type, L3912 Hand-finger orthosis (HFO), flexion glove with elastic finger control, prefabricated, off-the-shelf, L3913 HFO, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment, L3923 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. 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. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. Availity is solely responsible for its products and services. 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. In Kentucky: Anthem Health Plans of Kentucky, Inc. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, L3925 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), non-torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf. Let us know! Typically, we complete this review within two business days, and notify you and your provider of our decision. Updated June 02, 2022. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). In Ohio: Community Insurance Company. In Connecticut: Anthem Health Plans, Inc. 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. Future updates regarding COVID-19 will appear in the monthly Provider News publication. 2022 Electronic Forms LLC. Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Deutsch | Get Started Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas. Oromoo | 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). 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. P | 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. Use Availity to submit prior authorizations and check codes. 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. Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. Independent licensees of the Blue Cross Association. Italiano | 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. To stay covered, Medicaid members will need to take action. Please refer to the criteria listed below for genetic testing. 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. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. nor state or imply that you should access such website or any services, products or information which Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. Choose your location to get started. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. | In Maine: Anthem Health Plans of Maine, Inc. Electronic authorizations. 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. A new prior Do not sell or share my personal information. Medical Policy and Prior Authorization for Blue Plans. Inpatient services and nonparticipating providers always require prior authorization. Federal Employee Program. 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. Portugus | The best way to ensure you're submitting everything needed for a prior authorization is to use the prior authorization/precertification form at anthem.com/medicareprovider > Providers > Provider Resources > Forms and Guides. By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Select Auth/Referral Inquiry or Authorizations. Independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. Some procedures may also receive instant approval. Type at least three letters and we will start finding suggestions for you. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. Administrative. federal and Washington state civil rights laws. View the FEP-specific code list and forms. In the case of an emergency, you do not need prior authorization. The resources for our providers may differ between states. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Stay Covered When Medicaid Renewals Begin Medicaid renewals will start again soon. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. View medication policies and pre-authorization requirements. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in New Hampshire. Anthem is a registered trademark of Anthem Insurance Companies, Inc. In Indiana: Anthem Insurance Companies, Inc. This tool is for outpatient services only. ), 0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed), 0466T Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure. Expand All If yes, provide the medication name, dosage, duration of therapy, and outcome. Review requirements for Medicare Advantage members. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for No, the need for emergency services does not require prior authorization. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. View tools for submitting prior authorizationsfor Medicare Advantage members. under any circumstances for the activities, omissions or conduct of any owner or operator of any other 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 Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We currently don't offer resources in your area, but you can select an option below to see information for that state. All rights reserved. | The Blue Cross name and symbol are registered marks of the Blue Cross Association. Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. We also want to ensure you receive the right technology that addresses your particular clinical issue. You can also refer to the provider manual for information about services that require prior authorization. Type at least three letters and well start finding suggestions for you. | We're here to work with you, your doctor and the facility so you have the best possible health outcome. ), 0480T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. You are invited: Advancing Mental Health Equity for Youth & Young Adults. We look forward to working with you to provide quality services to our members. You can access the Precertification Lookup Tool through the Availity Portal. 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. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). The resources for our providers may differ between states. 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. Find care, claims & more with our new app. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). 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. Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. Please verify benefit coverage prior to rendering services. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. In Ohio: Community Insurance Company. Step 9 At the top of page 2, provide the patients name and ID number. Online - The AIM ProviderPortal is available 24x7. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members Use the search tool to find the Care Center closest to you. benefit certificate to determine which services need prior approval. 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. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. The CarelonRx member services telephone number is 833-279-0458. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. Use these lists to identify the member services that require prior authorization. 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 verify benefit coverage prior to rendering services. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. Prior authorization is not a guarantee of payment.