2005 - 2022 copyright of Anthem Insurance Companies, Inc. It may not display this or other websites correctly. For a better experience, please enable JavaScript in your browser before proceeding. Additional medical policies may be developed from time to time and some may be withdrawn from use. Interested in joining our provider network? Select Auth/Referral Inquiry or Authorizations. 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. 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. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. 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). Inpatient services and non-participating providers always require prior authorization. Health equity means that everyone has the chance to be their healthiest. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. We look forward to working with you to provide quality services to our members. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Start a Live Chat with one of our knowledgeable representatives. 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. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. 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. Explore our resources. There are several factors that impact whether a service or procedure is covered under a members benefit plan. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. We look forward to working with you to provide quality services to our members. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. We currently don't offer resources in your area, but you can select an option below to see information for that state. Do not sell or share my personal information. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. The resources on this page are specific to your state. Choose your location to get started. Type at least three letters and well start finding suggestions for you. To get started, select the state you live in. Price a medication, find a pharmacy,order auto refills, and more. Your browser is not supported. The resources for our providers may differ between states. Here you'll find information on the available plans and their benefits. Inpatient services and non-participating providers always require prior authorization. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Make your mental health a priority. You can also visit. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Or Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. For subsequent inpatient care, see 99231-99233. Prior Authorization Lookup. Our research shows that subscribers using Codify by AAPC are 33% more productive. It looks like you're in . Your browser is not supported. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Jan 1, 2020 Other ways to access: If you are currently accessing the Pre-certification / Pre-Authorization Requirements list through your health plans public website, this option is still available for you. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. E0731 Conductive garment for Tens 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 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. The Precertification Lookup Tool will let you know if clinical edits apply, information such as the medical necessity criteria used in making the authorization decision, and if a vendor is used -- without the need to make a phone call. A group NPI cannot be used as ordering NPI on a Medicare claim. 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. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. Youll also strengthen your appeals with access to quarterly versions since 2011. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. In Connecticut: Anthem Health Plans, Inc. 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. After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-224-0336. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. The doctors, hospitals, and other providers which are part of the network of providers referred to in this document are independent contractors who exercise independent judgment and over whom we have no control or right of control. We currently don't offer resources in your area, but you can select an option below to see information for that state. We update the Code List to conform to the most recent publications of CPT and HCPCS . Out-of-state providers. Vaccination is important in fighting against infectious diseases. Your browser is not supported. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. New member? The MCG guidelines we are licensed to use include ((1) Inpatient & Surgical Care (ISC), (2) General Recovery Care (GRG), (3) Recovery Facility Care (RFC), (4) Chronic Care (CC) and (5) Behavioral Health Care Guidelines (BHG). Not connected with or endorsed by the U.S. Government or the federal Medicare program. They are not agents or employees of the Plan. We look forward to working with you to provide quality service for our members. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. The resources for our providers may differ between states. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Choose your state below so that we can provide you with the most relevant information. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Current Procedural Terminology, more commonly known as CPT, refers to a medical code set created and maintained by the American Medical Association and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. Call Provider Services at 1-800-454-3730 (TTY 711) After hours, verify member eligibility by calling the 24/7 Nurse HelpLine at 1-800-600-4441. 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 Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Indiana: Anthem Insurance Companies, Inc. Choose your location to get started. Choose your state below so that we can provide you with the most relevant information. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. They are not agents or employees of the Plan. In Kentucky: Anthem Health Plans of Kentucky, Inc. You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed. The resources for our providers may differ between states. Review medical and pharmacy benefits for up to three years. Directions. Compare plans available in your area and apply today. Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2023. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Our resources vary by state. We look forward to working with you to provide quality service for our members. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. 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. out of your benefits, find the best healthcare, and stay healthy. Medicaid renewals will start again soon. We look forward to working with you to provide quality service for our members. If your state isn't listed, check out bcbs.com to find coverage in your area. Choose your location to get started. There is no cost for our providers to register or to use any of the digital applications. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. If your state isn't listed, check out bcbs.com to find coverage in your area. Reaching out to Anthem at least here on our. 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 were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Provider Medical Policies | Anthem.com Find information that's tailored for you. The doctors, hospitals, and other providers which are part of the network of providers referred to in this document are independent contractors who exercise independent judgment and over whom we have no control or right of control. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Our resources vary by state. Use the Prior Authorization tool within Availity. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. We look forward to working with you to provide quality service for our members. Call our Customer Service number, (TTY: 711). Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. National Accounts, Posts about using health Insurance and managing your health, Collections of learning resources and links to services, For Sydney Health users connect with others and find care programs. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. In Ohio: Community Insurance Company. 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. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Copyright 2023. Enter a CPT or HCPCS code in the space below. This tool is for outpatient services only. We offer flexible group insurance plans for any size business. 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. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. The resources on this page are specific to your state. You can also type part of the code's description to search, for example type "tonsil" to find "Removal of tonsils." This tool can be used to check if a prior authorization is required for health care services covered by Blue Cross and Blue Shield of Minnesota commercial health plans, Medicare Advantage and Platinum Blue. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. In Ohio: Community Insurance Company. If a prior authorization (PA) is required (indicates "yes" or "no") If there are PA conditions; If the service is a covered benefit (indicates "covered" or "not covered") CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. Find out if a service needs prior authorization. To stay covered, Medicaid members will need to take action. We currently don't offer resources in your area, but you can select an option below to see information for that state. Select Your State Where is the Precertification Lookup Tool located on Availity? Use the Prior Authorization tool within Availity OR. Members should discuss the information in the clinical UM guideline with their treating health care providers. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. For costs and complete details of the coverage, please contact your agent or the health plan. Our resources vary by state. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. You can access the Precertification Lookup Tool through the Availity Portal. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Please Select Your State The resources on this page are specific to your state. 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. Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). You must log in or register to reply here. It looks like you're in . Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. Please note: This tool is for outpatient services only. Access your member ID card from our website or mobile app. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. 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. Please note that services listed as requiring precertification may not be covered benefits for a member. 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. Understand your care options ahead of time so you can save time and money. Please verify benefit coverage prior to rendering services. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. Choose your location to get started. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare, Keyword database enhanced with medical acronyms and terminology, Default settings to lock in your preference for code-centered or range pages, Code Constructor to narrow down your code options one clickable range at a time, Lay terms and CPT code update information, An expanded index by service eases looking for a procedure or service.