The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Independent licensees of the Blue Cross and Blue Shield Association. We want you to receive the best care at the right time and place. Sign in to the appropriate website to complete your request. If your state isn't listed, check out bcbs.com to find coverage in your area. 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 refer to the criteria listed below for genetic testing. | Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . The site may not work properly. Get Started 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. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Espaol | As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Sign in to the appropriate website to complete your request. 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 Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. 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. The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. Inpatient services and nonparticipating providers always require prior authorization. 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. Let us know! 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. 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. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. . In Maine: Anthem Health Plans of Maine, 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. 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. View tools for submitting prior authorizationsfor Medicare Advantage members. In Ohio: Community Insurance Company. Online - The AIM ProviderPortal is available 24x7. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Deutsch | 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. Use Availity to submit prior authorizations and check codes. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. Use Availitys electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. Our electronic prior authorization (ePA) process is the preferred method for . Other Blue Plans pre-authorization requirements may differ from ours. State & Federal / Medicare. Your dashboard may experience future loading problems if not resolved. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. 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. 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. You further agree that ABCBS and its The CarelonRx member services telephone number is 833-279-0458. An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. Use the search tool to find the Care Center closest to you. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). The resources for our providers may differ between states. Kreyl Ayisyen | In Maine: Anthem Health Plans of Maine, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Use of the Anthem websites constitutes your agreement with our Terms of Use. It looks like you're in . In Indiana: Anthem Insurance Companies, Inc. To learn more read Microsoft's help article. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Electronic authorizations. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Find care, claims & more with our new app. Independent licensees of the Blue Cross Association. Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). Administrative. 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. 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. Please verify benefit coverage prior to rendering services. 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. View pre-authorization requirements for UMP members. In Kentucky: Anthem Health Plans of Kentucky, Inc. This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. Complete all member information fields on this form: Complete either the denial or the termination information section. You can also refer to the provider manual for information about services that require prior authorization. Type at least three letters and we will start finding suggestions for you. 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. State & Federal / Medicare. View requirements for Basic Option, Standard Option and FEP Blue Focus. 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). Anthem does not require prior authorization for treatment of emergency medical conditions. Step 9 At the top of page 2, provide the patients name and ID number. 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 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. 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. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. 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. Some procedures may also receive instant approval. 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 . Find a Care Center. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Expand All Choose your location to get started. 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 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. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. 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. 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.
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