ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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. Anthem offers great healthcare options for federal employees and their families. For your convenience, we've put these commonly used documents together in one place. CareFirst Commercial Pre-Service Review and Prior Authorization. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. CareFirst reserves the right to change this list at any time without notice. Provider Enrollment Forms. 494 0 obj <>stream Forms and information about pharmacy services and prescriptions for your patients. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. In addition, some sites may require you to agree to their terms of use and privacy policy. In Indiana: Anthem Insurance Companies, Inc. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Medicare Advantage. 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. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Anthem offers great healthcare options for federal employees and their families. This new site may be offered by a vendor or an independent third party. 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). This tool is for outpatient services only. 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 Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. The latest edition and archives of our monthly provider newsletter. endstream endobj 452 0 obj <. You'll also find news and updates for all lines of business. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. The site may also contain non-Medicare related information. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Referencing the . Do not sell or share my personal information. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. BlueCross BlueShield of Tennessee uses a clinical editing database. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Providers should continue to verify member eligibility and benefits prior to rendering services. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) This includes our Medicaid Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM(MA PPO) members. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. Expedited fax: 888-235-8390. Fax medical prior authorization request forms to: 844-864-7853 In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Effective 01/01/2023 (includes changes effective 04/01/2023) . For costs and complete details of the coverage, please contact your agent or the health plan. 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. This list contains notification/prior authorization requirements for inpatient and outpatient services. You can also check status of an existing request and auto-authorize more than 40 common procedures. Providers should call the prior authorization number on the back of the member ID card. Prior authorization list. 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 Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. These documents contain information about upcoming code edits. To view this file, you may need to install a PDF reader program. 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. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists 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. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Please check your schedule of benefits for coverage information. Here you'll find information on the available plans and their benefits. PPO outpatient services do not require Pre-Service Review. 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. You can also refer to the provider manual for information about services that require prior authorization. Use of the Anthem websites constitutes your agreement with our Terms of Use. Future updates regarding COVID-19 will appear in the monthly Provider News publication. 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. Please refer to the criteria listed below for genetic testing. 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. 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. In Indiana: Anthem Insurance Companies, Inc. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. 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. Forms and information about behavioral health services for your patients. This step will help you determine if prior authorization may be required for a specific member and service. 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. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q 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 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. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. In Maine: Anthem Health Plans of Maine, Inc. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. This approval process is called prior authorization. Type at least three letters and well start finding suggestions for you. Providers are responsible for verifying prior authorization requirements before services are rendered. 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.). You may also view the prior approval information in the Service Benefit Plan Brochures. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). Do not sell or share my personal information. In 2020, Part B step therapy may apply to some categories . Decide on what kind of signature to create. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. 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. 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. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. 2022 Standard Pre-certification list . In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. 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