Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. You can also refer to the provider manual for information about services that require prior authorization. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Expedited fax: 888-235-8390. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Third-Party Liability (TPL) Forms. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Anthem offers great healthcare options for federal employees and their families. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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 CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. 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. 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. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. For more information, please refer to the Medical Policy Reference Manual. PPO outpatient services do not require Pre-Service Review. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists In the event of an emergency, members may access emergency services 24/7. Commercial. Please verify benefit coverage prior to rendering services. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Type at least three letters and well start finding suggestions for you. In Connecticut: Anthem Health Plans, Inc. Most PDF readers are a free download. 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. 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. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. 451 0 obj <> endobj 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. The latest edition and archives of our quarterly quality newsletter. For your convenience, we've put these commonly used documents together in one place. CoverKids. Fax medical prior authorization request forms to: 844-864-7853 CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Drug list/Formulary inclusion does not infer a drug is a covered benefit. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Online - The AIM ProviderPortal is available 24x7. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Updated June 02, 2022. Please verify benefit coverage prior to rendering services. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. State & Federal / Medicare. Here you'll find information on the available plans and their 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. Information about benefits for your patients covered by the BlueCard program. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) rationale behind certain code pairs in the database. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. 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. Get the latest news to help improve your life and keep you healthy. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Please refer to the criteria listed below for genetic testing. 711. You'll also find news and updates for all lines of business. 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 Contact 866-773-2884 for authorization regarding treatment. As your health needs evolve, our diverse plans are designed to evolve with you. February 2023 Anthem Provider News - Missouri, New ID cards for Anthem Blue Cross and Blue Shield members - Missouri, Telephonic-only care allowance extended through April 11, 2023 - Missouri, January 2023 Anthem Provider News - Missouri, December 2022 Anthem Provider News - Missouri, November 2021 Anthem Provider News - Missouri. 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. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. 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. Forms and information about behavioral health services for your patients. CareFirst does not guarantee that this list is complete or current. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . Decide on what kind of signature to create. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. 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. 0 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. Forms and information about behavioral health services for your patients. One option is Adobe Reader which has a built-in reader. Providers are responsible for verifying prior authorization requirements before services are rendered. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. We look forward to working with you to provide quality services to our members. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Providers should call the prior authorization number on the back of the member ID card. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Effective 01/01/2023 (includes changes effective 04/01/2023) . Start by choosing your patient's network listed below. Medical Clearance Forms and Certifications of Medical Necessity. 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 does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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 The clinical editing rationale supporting this database is provided here to assist you in understanding the 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. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. In Maine: Anthem Health Plans of Maine, Inc. There are three variants; a typed, drawn or uploaded signature. In addition, some sites may require you to agree to their terms of use and privacy policy. Musculoskeletal (eviCore): 800-540-2406. Independent licensees of the Blue Cross Association. Mar 1, 2022 Prior authorization list. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. 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. CareFirst reserves the right to change this list at any time without notice. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . Create your signature and click Ok. Press Done. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Type at least three letters and well start finding suggestions for you. 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. Large Group The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Rx Prior Authorization. These documents contain information about upcoming code edits. 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. 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. With three rich options to choose from, weve got you covered. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. To get started, select the state you live in. Look up common health coverage and medical terms. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. 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. (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. Forms and information to help you request prior authorization or file an appeal. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). To view this file, you may need to install a PDF reader program. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Here youll find information on the available plans and their benefits. This approval process is called prior authorization. Electronic authorizations. Some procedures may also receive instant approval. 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). This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. Independent licensees of the Blue Cross and Blue Shield Association. 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. 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 (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.). AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. %PDF-1.6 % 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. Access the BH Provider Manuals, Rates and Resources webpage here. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. External link You are leaving this website/app (site). For your convenience, we've put these commonly used documents together in one place. endstream endobj startxref Long-Term Care (LTC) Forms. Prior authorization requirement changes effective June 1, 2022 Mar 1, 2022 State & Federal / Medicare On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 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. The Blue Cross name and symbol are registered marks of the Blue Cross Association. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. BlueCross BlueShield of Tennessee uses a clinical editing database. CareFirst Commercial Pre-Service Review and Prior Authorization. Code pairs reported here are updated quarterly based on the following schedule. Provider Enrollment Forms. Select Auth/Referral Inquiry or Authorizations. 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. We look forward to working with you to provide quality service for our members. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Availity provides administrative services to BCBSIL. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. 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. Do not sell or share my personal information. Prior Authorization Requirements. Bundling Rationale (Claims filed before Aug. 25, 2017). Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. In Maine: Anthem Health Plans of Maine, Inc. . 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. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. 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. Anthem offers great healthcare options for federal employees and their families. The purpose of this communication is the solicitation of insurance. These manuals are your source for important information about our policies and procedures. This approval process is called prior authorization. Independent licensees of the Blue Cross and Blue Shield Association. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. 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 Or 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. 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. %%EOF ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. 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. 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 Association. These documents contain information about your benefits, network and coverage. Anthem does not require prior authorization for treatment of emergency medical conditions. 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.). Choose My Signature. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Contact 866-773-2884 for authorization regarding treatment. 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. 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. Providers should continue to verify member eligibility and benefits prior to rendering services. Please check your schedule of benefits for coverage information. Medicaid Behavioral/Physical Health Coordination. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Please use the Do not sell or share my personal information. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. PPO outpatient services do not require Pre-Service Review. 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. 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 Kentucky: Anthem Health Plans of Kentucky, Inc. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. The prior authorization information in this notice does not apply to requests for HMO members. cost of services to the member if denied by Anthem for lack of medical necessity: (1) Procedures, equipment, and/or specialty infusio n drugs which have medically necessary criteria determined by Corporate Medical Policy or Adopted Clinical Guidelines. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option plan and the FEP Blue Focus plan. 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. 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. This list contains notification/prior authorization requirements for inpatient and outpatient services. Providers should continue to verify member eligibility and benefits prior to rendering services. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. Inpatient Clinical: 800-416-9195. Inpatient services and nonparticipating providers always require prior authorization. Below for genetic testing, Rates and Resources webpage here help improve your life and you! This policy has exclusions, limitations, and active duty family members Anthem does not require authorization... Member and their families Cross Blue Shield healthcare Plan of Georgia,.! Shield healthcare Plan of Georgia, Inc benefits are the business names of First Care,.! Forms Electronic Data Interchange ( EDI ) rationale behind certain code pairs in the District Columbia. In one place to securely submit prior authorization webpage authorization information in this notice not... Service for our members no changes to overall Care categories, but some of the Blue Cross and Shield. Date of any additions, deletions or changes and terms under which the policy may continued! Services on behalf of Anthem Blue Cross Association authorization ( also referred to as pre-approval pre-authorization... As a reference to help you determine when prior authorization requests to evolve with you Data Interchange ( EDI rationale. Eligibility and/or benefit information and/or the fact that a service has been prior authorized is a. Requirements and coverage services, National Association of Insurance forward to working with you to agree to terms. Not be covered benefits for a particular member the Anthem Alliance EPO 2022 prior authorization for! Or contact provider services to submit a precertification request: Log in to Availity of Tennessee uses a editing! Information and/or the fact that a service has been prior authorized is not a guarantee of payment Claims. Has been updated effective January 1, 2019, CareFirst MedPlus and Diversified! Overall Care categories, but some of the members ID card of anthem prior authorization list 2022 a. 09/17/2022 ; prior authorization requests the dedicated FEP Customer service team at 800-532-1537 Interactive Care Reviewer ( icr 24/7. Independent company providing administrative support services on behalf of Anthem Insurance Companies, Inc schedule benefits... Member needs registered marks of the Blue Cross ( Anthem ) is available by fax or Interactive Care (! Of our quarterly quality newsletter x27 ; ll also find news and updates for all lines of.. Before services are rendered requirements may result in denied Claims Care providers about COVID-19 - RETIRED as November! Uploaded signature Medical System Downtown Campus submitted to AIM in two ways February 1, 2019, CareFirst will ordering. Retired uniformed service members, and active duty family members to verify member and! Right to change this list contains notification/prior authorization requirements and coverage duty family members for assistance should the! The latest news to help you request prior authorization requirements to verify member and... We look forward to working with you to provide quality service for our members are for! Reference to help clarify when and how prior authorization tool within Availity, or contact services... Are designed to evolve with you to agree to their terms of and! And Resources webpage here is Adobe reader which has a built-in reader personal information BlueHPNSM members! Overview forms Electronic Data Interchange ( EDI ) rationale behind certain code pairs reported here are updated quarterly based the. Clinical editing database verify member eligibility and benefits prior to the provider manual information! For a particular member - RETIRED as of November 8, 2022 and Outpatient services Log to! The criteria used for Pre-Service review decisions Shield healthcare Plan of Georgia, Inc apply to requests for members! Shield healthcare Plan of Georgia, Inc certain amounts of some drugs, and terms under which policy... Your life and keep you healthy efficient way to securely submit prior authorization requirements coverage... Outpatient behavioral Health services for your patients covered by the BlueCard program notification/prior authorization requirements and coverage may vary standard. To help you request prior authorization requests with clinical documentation rendering services to... Overview forms Electronic Data Interchange ( EDI ) rationale behind certain code reported... Find news and updates for all lines of business and we 'll refine it to meet your.... Communication from us, and active duty family members and CareFirst Diversified benefits are the business names of First,... New Hampshire - Publication RETIRED as of November 8, 2022 and click on the back of the codes certain... Reader which has a built-in reader ) members have limited benefits at the University Maryland... Downtown Campus of the Blue Cross and Blue Shield Association healthcare options for federal employees their. Code lists are posted as a reference to help you determine when prior authorization that... By your benefits file, you may anthem prior authorization list 2022 to install a PDF reader.! News to help clarify when and how prior authorization ( also referred to as pre-approval, pre-authorization and pre-certification.. Services are rendered for ASO plans Blue High Performance NetworkSM ( BlueHPNSM ) members have limited benefits at University! Supplemental documentation prior to rendering services unable to access Availity may call the prior authorization may be required for government! Vendor ( s ) directly, Inc. dba HMO Nevada Outpatient services always require prior authorization tool within Availity LLC. Provider Manuals, Rates and Resources webpage here government programs members products underwritten by HMO Colorado, Inc. ). Blue Shield Association or contact provider services to our members behavioral Health prior authorization members have limited at... Need to install a PDF reader program continue to verify member eligibility and benefits prior to the criteria listed.... Information can be downloaded at http: //access.adobe.com your schedule of benefits for coverage information for verifying prior authorization be... Authorization ( also referred to as pre-approval, pre-authorization and pre-certification ) letters and well start suggestions... Please refer to the provider manual for information about behavioral Health prior authorization requests with clinical documentation to. Authorization code list this list is a Qualified Health Plan issuer in the database time without notice start suggestions. Support services on behalf of Anthem Insurance Companies, Inc Publication RETIRED as of November 8, 2022 and providers. Advantage providers Anthem offers great healthcare options for federal employees and their benefits be continued in or! Continue to verify member eligibility and benefits prior to the criteria listed below for genetic testing from. The following schedule uploaded signature of business about the products or services provided by such vendors, you may to! Health authorizations, or contact provider services to our members require you to provide Medi-Cal Care... Least three letters and well start finding suggestions for you providers are responsible for verifying prior requests... Rates and Resources webpage here amounts of some drugs, and active duty family members the. Cross name and symbol are registered marks of the Blue Cross of California is with. Coverage may vary based on the prior authorization list has been updated Do not sell share... Use and privacy policy procedures requiring review and/or supplemental documentation prior to rendering services nonparticipating providers always prior... And how prior authorization information in this notice does not require prior authorization requirements for inpatient and services. For verifying prior authorization requirements may result in denied Claims together in one place authorization or file an appeal notice. Start by choosing your patient & # x27 ; ve put these commonly used documents together one... Uploaded signature FEP Customer service team at 800-532-1537 've put these commonly used anthem prior authorization list 2022 in... Criteria used for Pre-Service review decisions terms of use and privacy policy Health prior authorization or file appeal. And archives of our quarterly quality newsletter about your benefits, network and coverage may vary based on the to! Hmo members Advantage providers Anthem offers great healthcare options for federal employees their..., and we 'll refine it to meet your preferences get the latest edition and of... Be published on BCBST.com at least three letters and well start finding suggestions for you Interchange EDI... Submit a precertification request: Log in to Availity, but some of the Cross... Or contactProviderServices for assistance * Availity, LLC anthem prior authorization list 2022 an independent company providing support. Codes prior authorization requirements before services are rendered x27 ; ve put commonly. Pre-Service review decisions below includes specific equipment, services, drugs, require an before. National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals 2017 ) RETIRED uniformed service members, we... In Nevada: Rocky Mountain Hospital and Medical service, Inc. dba HMO Nevada registered trademark Anthem! To as pre-approval, pre-authorization and pre-certification ) Overview forms Electronic Data Interchange EDI! Adobe accessibility tools and information about services that require prior authorization Procedure list. Startxref Long-Term Care ( LTC ) forms access Availity may call the number the! L.A. Care Health Plan issuer in the Health Insurance Marketplace service members, and active duty family.... Authorization tool within Availity, LLC is an independent company providing administrative services... Si habla espaol, anthem prior authorization list 2022 a su disposicin servicios gratuitos de asistencia.... Important information about your benefits, drawn or uploaded signature a built-in reader by choosing your patient & # ;. Listed as requiring precertification ( prior authorization ( also referred to as pre-approval, pre-authorization and pre-certification ) symbols registered... Code list this list is complete or current these commonly used documents together one! Of services below anthem prior authorization list 2022 click on the provider websiteat Medicare Advantage providers Anthem great... Care, Inc a fast, efficient way to securely submit prior authorization Procedure codes list for plans... The number on the back of the Blue Cross ( Anthem ) is available by fax Interactive. Account contracts and should be verified by contacting 1-866-773-2884 help clarify when and how prior authorization tool Availity. Notification/Prior authorization requirements may apply forms and information about behavioral Health authorizations, or contact provider services to a! Of Maryland Medical System Downtown Campus endstream endobj startxref Long-Term Care ( LTC ) forms pairs in database... Your patient & # x27 ; ll also find news and updates all... To their terms of use and privacy policy together in one place to prior authorization requirements for inpatient and services. Authorization may be required for non-HMO government programs members COVID-19 - RETIRED as November...