Your online account is a powerful tool for managing every aspect of your health insurance plan. Copyright 2023. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. 711. 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. ET. Please verify benefit coverage prior to rendering services. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). 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. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. You can also visit bcbs.com to find resources for other states. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Call our Customer Service number, (TTY: 711). We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. 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. 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. 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. You can also visit bcbs.com to find resources for other states. 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. 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. Find drug lists, pharmacy program information, and provider resources. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Our research shows that subscribers using Codify by AAPC are 33% more productive. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. The resources for our providers may differ between states. There is no cost for our providers to register or to use any of the digital applications. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Jan 1, 2020 Quickly and easily submit out-of-network claims online. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. Please update your browser if the service fails to run our website. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. Choose your location to get started. 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. Choose your state below so that we can provide you with the most relevant information. New member? The resources for our providers may differ between states. Find drug lists, pharmacy program information, and provider resources. Choose your location to get started. We currently don't offer resources in your area, but you can select an option below to see information for that state. It looks like you're in . It looks like you're in . Pay outstanding doctor bills and track online or in-person payments. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. Choose your location to get started. Please verify benefit coverage prior to rendering services. If you arent registered to use Availity, signing up is easy and 100% secure. 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. Use our app, Sydney Health, to start a Live Chat. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 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. 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. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. Health equity means that everyone has the chance to be their healthiest. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. Members should contact their local customer service representative for specific coverage information. Access eligibility and benefits information on the Availity* Portal OR. 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. Please update your browser if the service fails to run our website. Large Group 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. You can also visit. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Understand your care options ahead of time so you can save time and money. For subsequent inpatient care, see 99231-99233. 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. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Anthem offers great healthcare options for federal employees and their families. 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. A group NPI cannot be used as ordering NPI on a Medicare claim. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Contact will be made by an insurance agent or insurance company. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Where is the Precertification Lookup Tool located on Availity? You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. In Maine: Anthem Health Plans of Maine, Inc. If your state isn't listed, check out bcbs.com to find coverage in your area. We currently don't offer resources in your area, but you can select an option below to see information for that state. Additional medical policies may be developed from time to time and some may be withdrawn from use. Your dashboard may experience future loading problems if not resolved. 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). Use of the Anthem websites constitutes your agreement with our Terms of Use. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Vaccination is important in fighting against infectious diseases. Administrative / Digital Tools, Learn more by attending this live webinar. Please verify benefit coverage prior to rendering services. Our call to Anthem resulted in a general statement basically use a different code. Our resources vary by state. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Review medical and pharmacy benefits for up to three years. 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. Interested in joining our provider network? For a better experience, please enable JavaScript in your browser before proceeding. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. We update the Code List to conform to the most recent publications of CPT and HCPCS . Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). This tool is for outpatient services only. Directions. 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. There are several factors that impact whether a service or procedure is covered under a members benefit plan. Your browser is not supported. Provider Medical Policies | Anthem.com Find information that's tailored for you.
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