anthem blue cross prior authorization list

benefit certificate to determine which services need prior approval. 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. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. With prior authorization, Blue Cross of Idaho is able to: Prior authorization is just one of the ways we're working to save our members money and address rising healthcare costs. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). More prior authorization resources Sign in to Availity Prior-Authorization And Pre-Authorization | Anthem.com Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Pharmacy Information for Providers | Anthem.com - Empire Blue View pre-authorization requirements for UMP members. Use Availity to submit prior authorizations and check codes. Some procedures may also receive instant approval. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. 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 . We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. It looks like you're outside the United States. This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. We look forward to working with you to provide quality services to our members. In some cases, we require more information and will request additional records so we can make a fully informed decision. In the event of an emergency, members may access emergency services 24/7. To learn more read Microsoft's help article. ), 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. In Maine: Anthem Health Plans of Maine, Inc. Do not sell or share my personal information. Your plan has a list of services that require prior authorization. It looks like you're in . 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. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Use of the Anthem websites constitutes your agreement with our Terms of Use. Updated June 02, 2022. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). ABCBS makes no warranties or representations of any kind, express or implied, nor In Connecticut: Anthem Health Plans, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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 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. Find care, claims & more with our new app. Posted Jan. 11, 2021. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. View medication policies and pre-authorization requirements. Provider Communications Once you choose to link to another website, you understand and agree that you have exited this Please refer to the criteria listed below for genetic testing. Prior-Authorization And Pre-Authorization | Anthem.com Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Your browser is not supported. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM 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. of all such websites. Prior authorization/precertification form notification - Anthem Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Complete all member information fields on this form: Complete either the denial or the termination information section. PDF Outpatient Prior Authorization Code - Blue Cross Blue Shield of Please update your browser if the service fails to run our website. Medical Policy and Prior Authorization for Blue Plans. 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. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. under any circumstances for the activities, omissions or conduct of any owner or operator of any other 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. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. nor state or imply that you should access such website or any services, products or information which Looks like you're using an old browser. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In Indiana: Anthem Insurance Companies, Inc. Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. Step 9 At the top of page 2, provide the patients name and ID number. In the case of an emergency, you do not need prior authorization. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity is solely responsible for its products and services. 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). | Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. 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. 2022 Electronic Forms LLC. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. Anthem partners with health care professionals to close gaps in care and improve members overall heath. 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. Polski | 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. This form should only be used for Arkansas Blue Cross and Blue Shield members. Get Started Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. This tool is for outpatient services only. 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 third-party website link available as an option to you, ABCBS does not in any way endorse any such website, You are invited: Advancing Mental Health Equity for Youth & Young Adults. L3927 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (for example, static or ring type), may include soft interface material, prefabricated, L5301 Below knee, molded socket, shin, SACH foot, endoskeletal system, L5321 Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee, L5645 Addition to lower extremity, below knee (BK), flexible inner socket, external frame, L5649 Addition to lower extremity, ischial containment/narrow M-L socket, L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each, 0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed, 0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Typically, we complete this review within two business days, and notify you and your provider of our decision. 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. Easily obtain pre-authorization and eligibility information with our tools. Choose your location to get started. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. Ting Vit | 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. Important: Blueprint Portal will not load if you are using Internet Explorer. Prior Authorization Requirements | California Provider - Anthem Blue Cross Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Find a Doctor | CareMore Health Prior authorization list | Blue Shield of CA Provider 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. 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. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. The site may not work properly. 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. The CarelonRx member services telephone number is 833-279-0458. Italiano | In Connecticut: Anthem Health Plans, Inc. Other Blue Plans pre-authorization requirements may differ from ours. 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. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Select Auth/Referral Inquiry or Authorizations. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. Select Auth/Referral Inquiry or Authorizations. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). Use of the Anthem websites constitutes your agreement with our Terms of Use. Do you offer telehealth services? 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. P | In the case of a medical emergency, you do not need prior authorization to receive care. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). To stay covered, Medicaid members will need to take action. 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. Have you reviewed your online provider directory information lately? Independent licensees of the Blue Cross and Blue Shield Association. 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. Contact 866-773-2884 for authorization regarding treatment. 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. 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. 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. 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 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. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. The resources for our providers may differ between states. link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to Our resources vary by state. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. may be offered to you through such other websites or by the owner or operator of such other websites. We also want to ensure you receive the right technology that addresses your particular clinical issue. 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. State & Federal / Medicare. PDF Authorization requirements by product - Blue Cross Blue Shield of ), 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. 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. March 2023 Anthem Provider News - New Hampshire. 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. Inpatient services and nonparticipating providers always require prior authorization. In Kentucky: Anthem Health Plans of Kentucky, Inc. View tools for submitting prior authorizationsfor Medicare Advantage members. Federal Employee Program. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. Non-individual members Use Availity to submit prior authorizations and check codes. In Ohio: Community Insurance Company. Prior authorization lookup tool | NY Provider - Empire Blue Cross

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