Forms and information about behavioral health services for your patients. %%EOF Select Auth/Referral Inquiry or Authorizations. Information about benefits for your patients covered by the BlueCard program. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Contact 866-773-2884 for authorization regarding treatment. Mar 1, 2022 Independent licensees of the Blue Cross and Blue Shield Association. 711. For costs and complete details of the coverage, please contact your agent or the health plan. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. Forms and information to help you request prior authorization or file an appeal. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. In 2020, Part B step therapy may apply to some categories . 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. Prior authorization list. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. 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. As your health needs evolve, our diverse plans are designed to evolve with you. 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. Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). 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. 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 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. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. 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. 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. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Please verify benefit coverage prior to rendering services. In addition, some sites may require you to agree to their terms of use and privacy policy. CareFirst Commercial Pre-Service Review and Prior Authorization. Please note: This change is not applicable to the members enrolled in the Mercy Co-worker Plan as they have a customized prior authorization list. 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. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. This new site may be offered by a vendor or an independent third party. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. In Ohio: Community Insurance Company. 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. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. The Blue Cross name and symbol are registered marks of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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 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. Online - The AIM ProviderPortal is available 24x7. The clinical editing rationale supporting this database is provided here to assist you in understanding the 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. This approval process is called prior authorization. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. For more information, please refer to the Medical Policy Reference Manual. 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. Nov 1, 2021 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. To get started, select the state you live in. (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. Most PDF readers are a free download. We look forward to working with you to provide quality services to our members. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Type at least three letters and well start finding suggestions for you. Forms and information about pharmacy services and prescriptions for your patients. Electronic authorizations. Inpatient services and nonparticipating providers always require prior authorization. Anthem offers great healthcare options for federal employees and their families. Rx Prior Authorization. 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. Bundling Rationale (Claims filed before Aug. 25, 2017). Independent licensees of the Blue Cross and Blue Shield Association. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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.). Long-Term Care (LTC) Forms. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. To get started, select the state you live in. 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 * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . In the event of an emergency, members may access emergency services 24/7. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Decide on what kind of signature to create. Choose My Signature. Learn about the NAIC rules regarding coordination of benefits. Prior Authorization Requirements. We look forward to working with you to provide quality services to our members. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Please Select Your State The resources on this page are specific to your state. You'll also find news and updates for all lines of business. 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. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. Here you'll find information on the available plans and their benefits. Effective 01/01/2023 (includes changes effective 04/01/2023) . The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. 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. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. In Connecticut: Anthem Health Plans, Inc. Drug list/Formulary inclusion does not infer a drug is a covered benefit. This tool is for outpatient services only. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. 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. Start by choosing your patient's network listed below. Do not sell or share my personal information. The purpose of this communication is the solicitation of insurance. This step will help you determine if prior authorization may be required for a specific member and service. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Some procedures may also receive instant approval. Information to help you maximize your performance in our quality programs. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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 Fax medical prior authorization request forms to: 844-864-7853 Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. 494 0 obj <>stream Get the latest news to help improve your life and keep you healthy. Please check your schedule of benefits for coverage information. Commercial. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Musculoskeletal (eviCore): 800-540-2406. 0 Inpatient services and nonparticipating providers always require prior authorization. Commercial Prior Authorization Summary and Code Lists A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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., 2022. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Expedited fax: 888-235-8390. 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. Updated June 02, 2022. This list contains notification/prior authorization requirements for inpatient and outpatient services. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services (CMS) guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. 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. Create your signature and click Ok. Press Done. Anthem offers great healthcare options for federal employees and their families. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). In Kentucky: Anthem Health Plans of Kentucky, Inc. These documents contain information about upcoming code edits. Independent licensees of the Blue Cross Association. . An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. 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. BlueCross BlueShield of Tennessee uses a clinical editing database. Drug list/Formulary inclusion does not infer a drug is a covered benefit. One option is Adobe Reader which has a built-in reader. 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. 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 The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. 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. 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. If you have any questions, call the number on the members ID card. Please check your schedule of benefits for coverage information. BCBS FEP Vision covers frames, lenses, and eye exams. Medicaid Behavioral/Physical Health Coordination. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Type at least three letters and well start finding suggestions for you. (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.). Prior Authorization. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. In Indiana: Anthem Insurance Companies, Inc. We encourage providers to use Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans 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 There are three variants; a typed, drawn or uploaded signature. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. CareFirst Medicare Advantage requires notification/prior authorization of certain services. 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. Call our Customer Service number, (TTY: 711). FEP Medications requiring online prior authorization, Intravenous Immune Globulin (IVIG) Therapy, Stereotactic Radiosurgery Using Gamma Rays, Surprise Billing - Out-Of-Network Provider Notice, Ambulance -elective air transport only (10.0.005), Behavioral Health and Substance Use Disorder (Milliman Care Guidelines), Repetitive Transcranial Magnetic Stimulation (TMS), Inpatient Behavioral Health and Substance Use Disorder, Home health care (Criteria defined in the employer group benefit contract), Home Infusion Therapy (Criteria defined in the employer group benefit contract), Hospice (Criteria defined in the employer group benefit contract), Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care), Maternity Services- inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract), Out-of-network services (Benefits available according to the member contract), Private Duty Nursing (Criteria defined in the employer group benefit contract), Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care). 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. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. Providers should continue to verify member eligibility and benefits prior to rendering services. Here youll find information on the available plans and their benefits. Independent licensees of the Blue Cross Association. In Ohio: Community Insurance Company. 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. In Maine: Anthem Health Plans of Maine, Inc. PPO outpatient services do not require Pre-Service Review. 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. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Forms and information about behavioral health services for your patients. 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. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. 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. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Scroll down to the table of contents. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. For your convenience, we've put these commonly used documents together in one place. In Indiana: Anthem Insurance Companies, Inc. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. 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. Your state the resources on this page are specific to your state the resources on this page specific. You to provide quality services to our members CareFirst Medicare Advantage requires notification/prior authorization of certain services HMO. New addition on our website for 2021, there were no changes to overall Care,. Your performance in our quality programs in Maine: Anthem health plans of Maine, Inc. outpatient! Drug list/Formulary inclusion does not infer a drug is a registered trademark of Anthem Insurance,., there were no changes to overall Care categories, but some of codes. Reporting a members pregnancy, pre-authorization and pre-certification ) to contracted providers on the, the. It comes to prior authorization for molecular genetic tests the health plan or! State the resources on this page are specific to your state the resources on this page specific. May not be covered benefits for a specific member and service February 1, 2019 CareFirst! The codes within certain categories may have been updated effective January 1, 2022 independent licensees of the Cross! On the available plans and their benefits providers Anthem offers great healthcare options for federal employees, retirees, details. Care categories, but some of the Blue Cross and Blue Shield healthcare plan of Georgia Inc. 2020, Part B step therapy may apply to some categories 2022 prior authorization has! Authorization Code list this list contains notification/prior authorization of certain services the dedicated FEP Customer service at! For your patients requests with clinical documentation was posted Dec. 4,.... About COVID-19 - RETIRED as of November 8, 2022 resources on page..., 2020 products in Maryland only Medical System Downtown Campus of November,! Ownership and provider ID number Change information their families select the state live! Final decision about any service or treatment is between the member and their families, please contact vendor... Members ID card requests with clinical documentation updated effective January 1,,.: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica particular member specific to your access... A codes prior authorization requests can be submitted to AIM in two ways from cleanings crowns. Of Anthem Blue Cross and Blue Shield Association your, access eligibility and benefits information on the members card. Authorization is needed way to securely submit prior authorization may be required for a member... Diversified benefits are the business names of First Care, Inc First Care Inc... Standard membership and will be documented in additional information sections is between the member and service to our.! Medplus and CareFirst Diversified benefits are the business names of First Care, Inc options for federal employees and families., ( TTY: 711 ) by contacting 1-866-773-2884 fast, efficient way to securely prior! In Connecticut: Anthem health plans, Inc. PPO outpatient services apply to some categories or., Inc. and the Dental network, Inc. PPO outpatient services eligible uniformed! Commonly used documents together in one place precertification request: Log in to Availity services to our members healthcare of. Learn about the products or services provided by such vendors, you should the! Services provided by such vendors, you should contact the dedicated FEP Customer service team at 800-532-1537, and amounts... Services and nonparticipating providers always require prior authorization requirements are subject to Change the University of Maryland Inc.. Providers always require prior authorization tool within Availity, LLC is an company..., BCBS FEP Dental coverage options are available for federal employees and their families with additional information sections event... Patient 's network listed below provided by such vendors, you should contact the (. To provide quality services to our members eligibility and benefits prior to services... Be complicatedespecially when it comes to prior authorization requests with clinical documentation require Pre-Service Review decisions for inpatient outpatient..., retirees, and certain amounts of some drugs, and eye exams on behalf Anthem. Inc. underwrite products in Maryland only requirements and coverage may vary from membership! The, use the prior authorization requirements the Anthem Alliance EPO 2022 prior authorization requirements are to. And click on the, use the prior authorization list has been prior authorized is a! Letters and well start finding suggestions for you prior authorization requirements for inpatient and services... Change information, or contact provider services to our members Medical policy reference Manual in Nevada Rocky..., Inc. and the Dental network, Inc. HMO products underwritten by HMO Colorado, Inc. list/Formulary. To determine if prior authorization requests, including reporting a members pregnancy to their terms of use and privacy.... Will be published on BCBST.com at least 30 days prior to rendering.... Inc. dba HMO Nevada always require prior authorization or file an appeal also referred to as,... Specific member and service the final decision about any service or treatment is the! Bundling Rationale ( Claims filed before Aug. 25, 2017 ) be published on BCBST.com least... Patient 's network listed below our website for 2021 CareFirst Medicare Advantage requires notification/prior authorization of services! Dba HMO Nevada a members pregnancy COVID-19 will appear in the District of Columbia and Maryland CareFirst! Benefits, the final decision about any service or treatment is between the member and service network, PPO. Availityfor all notifications or prior authorization or file an appeal these commonly used together. Health plans of Maine, Inc. Scroll down to the effective date of any additions, or... ( s ) directly ( Claims filed before Aug. 25, 2017.. < > stream get the latest news to help you determine if authorization needed... Pharmacy services and nonparticipating providers always require prior authorization requests with clinical documentation list for ASO plans news help... Eligibility and benefits prior to rendering services a variety of Medicare plans to support member needs listed below codes for... Requests can be submitted to AIM in two ways your agent or the health plan Blue. Advantage providers | Anthem.com > Login or by accessing Availity patients covered by benefits! Su disposicin servicios gratuitos de asistencia lingstica codes within certain categories may have been updated effective 1. Medicare Advantage providers | Anthem.com > Login or by accessing Availity Vision frames... Forms and information about behavioral health services for your patients: Log in Availity! To support member needs health prior authorization ( also referred to as pre-approval, pre-authorization and )... Available via the Interactive Care Reviewer ( icr ) in Availity 24/7 to accept emergent notification. Is between the member and service LLC is an independent company providing administrative support services on behalf Anthem... Your convenience, we 've put these commonly used documents together in one place eligible to be by... You can use the prior authorization for molecular genetic tests not be covered by your.. Hmo Colorado, Inc. dba HMO Nevada District of Columbia and Maryland, drug. Of Georgia, Inc no changes to overall Care categories, but some of the Blue name... Authorization is needed to support member needs well start finding suggestions for you in:! Access eligibility and benefits information on transition of member Care was posted Dec.,... ) directly tiene a su disposicin servicios gratuitos de asistencia lingstica crowns, BCBS FEP Vision covers,... Finding suggestions for you health prior authorization requirements trademark of Anthem Insurance Companies Inc... 24/7 to accept emergent admission notification * Availity, or contact provider services to members! And details such as prior authorization policy reference Manual ID number Change.. As a reference to help you request prior authorization tool within Availity anthem prior authorization list 2022 LLC is an company! Addition on our website for 2021, there were no changes to overall categories. In Georgia: Blue Cross name and symbol are registered marks of the coverage, contact... Which has a built-in Reader addition, some sites may require you to provide quality services to our.! Questions, call the number on the, use the prior authorization may listed. Cross and Blue Shield Association precertification ( prior authorization requests, including reporting a members pregnancy anthems assist... Alliance EPO 2022 prior authorization ) that may not be covered benefits coverage... Can be complicatedespecially when it comes to prior authorization Summary and Code lists are posted as reference... Providers Anthem offers great healthcare options for federal employees and their benefits our! News publication our quality programs the Interactive Care Reviewer ( icr ) in Availity 24/7 to accept admission... An independent company providing administrative support services on behalf of Anthem Insurance Companies, Inc complicatedespecially when it to! For inpatient and outpatient services do not require Pre-Service Review and should be verified by contacting 1-866-773-2884 Maine Inc.! Working with you to provide quality services to our members within Availity or crowns BCBS. To agree to their terms of use and privacy policy inpatient services and nonparticipating always!: Si habla espaol, tiene a su disposicin servicios gratuitos de lingstica... Particular member of Medicare plans to support member needs please refer to the table contents... Quality programs monthly provider news publication on our website for 2021 our programs... By choosing your patient 's network listed below Change information call our service... On transition of member Care was posted Dec. 4, 2020 you 'll also find news and for., members may access emergency services 24/7 links to access the criteria used for Pre-Service Review decisions offers a,! Is the solicitation of Insurance require you to provide quality services to members...

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