Access your member ID card from our website or mobile app. There is no cost for our providers to register or to use any of the digital applications. 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. Copyright 2023. The resources for our providers may differ between states. Taking time for routine mammograms is an important part of staying healthy. This tool is for outpatient services only. 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 offer flexible group insurance plans for any size business. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. We look forward to working with you to provide quality services to our members. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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). Prior Authorization Lookup. JavaScript is disabled. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. We look forward to working with you to provide quality services to our members. Select Auth/Referral Inquiry or Authorizations. Your dashboard may experience future loading problems if not resolved. Please verify benefit coverage prior to rendering services. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. Understand your care options ahead of time so you can save time and money. Our resources vary by state. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. Administrative / Digital Tools, Learn more by attending this live webinar. Members should discuss the information in the medical policies with their treating health care professionals. Your dashboard may experience future loading problems if not resolved. It looks like you're in . These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. Please update your browser if the service fails to run our website. 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. 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. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. The purpose of this communication is the solicitation of insurance. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Our resources vary by state. It looks like you're outside the United States. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manualand support for delivering benefits to our members. The resources for our providers may differ between states. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. To get started, select the state you live in. The medical policies do not constitute medical advice or medical care. 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. Your online account is a powerful tool for managing every aspect of your health insurance plan. The resources on this page are specific to your state. Search by keyword or procedure code for related policy information. In Connecticut: Anthem Health Plans, Inc. If your state isn't listed, check out bcbs.com to find coverage in your area. We offer affordable health, dental, and vision coverage to fit your budget. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). 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. Please verify benefit coverage prior to rendering services. We are also licensed to use MCG guidelines to guide utilization management decisions. Enter a CPT or HCPCS code in the space below. In Indiana: Anthem Insurance Companies, Inc. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. 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. It looks like you're outside the United States. Choose your location to get started. These guidelines do not constitute medical advice or medical care. Apr 1, 2022 The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Provider Medical Policies | Anthem.com Find information that's tailored for you. 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 Kentucky: Anthem Health Plans of Kentucky, Inc. Type at least three letters and well start finding suggestions for you. We look forward to working with you to provide quality services to our members. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Medicaid renewals will start again soon. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Out-of-state providers. Anthem offers great healthcare options for federal employees and their families. 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. 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. The resources for our providers may differ between states. Additional medical policies may be developed from time to time and some may be withdrawn from use. 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. Find a Medicare plan that fits your healthcare needs and your budget. Members should discuss the information in the clinical UM guideline with their treating health care providers. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Your browser is not supported. 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. 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. This tool is for outpatient services only. Access resources to help health care professionals do what they do bestcare for our members. 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. Compare plans available in your area and apply today. In Maine: Anthem Health Plans of Maine, Inc. Audit reveals crisis standards of care fell short during pandemic. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Not connected with or endorsed by the U.S. Government or the federal Medicare program. In Ohio: Community Insurance Company. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. Inpatient services and non-participating providers always require prior authorization. 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. 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. Pay outstanding doctor bills and track online or in-person payments. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. In Kentucky: Anthem Health Plans of Kentucky, Inc. Available for iOS and Android devices. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Reimbursement Policies. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. 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. Please update your browser if the service fails to run our website. Choose your state below so that we can provide you with the most relevant information. Our research shows that subscribers using Codify by AAPC are 33% more productive. You must log in or register to reply here. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Where is the Precertification Lookup Tool located on Availity? 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Our call to Anthem resulted in a general statement basically use a different code. We currently don't offer resources in your area, but you can select an option below to see information for that state. Members should contact their local customer service representative for specific coverage information. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. We currently don't offer resources in your area, but you can select an option below to see information for that state. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. 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. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions.
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