It looks like you're in . Use the Prior Authorization tool within Availity OR. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Vaccination is important in fighting against infectious diseases. 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. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Provider Medical Policies | Anthem.com Find information that's tailored for you. Pay outstanding doctor bills and track online or in-person payments. 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. You can also visit. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. 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. 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. Prior Authorization Lookup. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. We look forward to working with you to provide quality services to our members. 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. 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") The tool will tell you if that service needs . The purpose of this communication is the solicitation of insurance. Your browser is not supported. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. Our call to Anthem resulted in a general statement basically use a different code. 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. You can access the Precertification Lookup Tool through the Availity Portal. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. 711. 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. Lets make healthy happen. The resources for our providers may differ between states. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Medical policies can be highly technical and complex and are provided here for informational purposes. ET. In Ohio: Community Insurance Company. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. 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. It looks like you're outside the United States. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. In Kentucky: Anthem Health Plans of Kentucky, Inc. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. We currently don't offer resources in your area, but you can select an option below to see information for that state. Please verify benefit coverage prior to rendering services. In Kentucky: Anthem Health Plans of Kentucky, Inc. Your dashboard may experience future loading problems if not resolved. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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. For a better experience, please enable JavaScript in your browser before proceeding. For costs and complete details of the coverage, please contact your agent or the health plan. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Choose your location to get started. It looks like you're outside the United States. To get started, select the state you live in. Our research shows that subscribers using Codify by AAPC are 33% more productive. Choose your state below so that we can provide you with the most relevant information. Anthem offers great healthcare options for federal employees and their families. Please update your browser if the service fails to run our website. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. We want to help physicians, facilities and other health care professionals submit claims accurately. 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. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Or With Codify by AAPC cross-reference tools, you can check common code pairings. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. 2005 - 2022 copyright of Anthem Insurance Companies, 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. All other available Medical Policy documents are published by policy/topic title. We look forward to working with you to provide quality service for our members. In Indiana: Anthem Insurance Companies, Inc. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Your online account is a powerful tool for managing every aspect of your health insurance plan. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Enter one or more keyword (s) for desired policy or topic. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Our resources vary by state. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. Contact will be made by an insurance agent or insurance company. We look forward to working with you to provide quality service for our members. Prior authorizations are required for: All non-par providers. The resources for our providers may differ between states. Your browser is not supported. Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment, Indiana Medicaid Prior Authorization Requirements List, New Option Available for Indiana Market. 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. Large Group March 2023 Anthem Provider News - Missouri, 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, April 2022 Anthem Provider News - Missouri, enable member benefit lookup by CPT and HCPC procedure codes, Enter up to eight procedure codes per transaction, provide additional cost share information by place of service, return Is Authorization Required? information, include additional plan-level benefit limitations. Once youve accessed the Precertification Lookup Tool, choose a line of business from the menu selection offered, and then type the CPT/HCPCS code or a code description to determine if a prior authorization is required. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. Please update your browser if the service fails to run our website. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. You can also visit bcbs.com to find resources for other states. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. They are not agents or employees of the Plan. Medicare Complaints, Grievances & Appeals. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Were committed to supporting you in providing quality care and services to the members in our network. 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. State & Federal / Medicaid. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) Choose your location to get started. This tool is for outpatient services only. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. We currently don't offer resources in your area, but you can select an option below to see information for that state. They are not agents or employees of the Plan. These guidelines do not constitute medical advice or medical care. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. You can also visit. We look forward to working with you to provide quality services to our members. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. We currently don't offer resources in your area, but you can select an option below to see information for that state. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). 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. Reaching out to Anthem at least here on our.