The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. may be offered to you through such other websites or by the owner or operator of such other websites. This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. | | Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. 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. Updated June 02, 2022. In Ohio: Community Insurance Company. of all such websites. under any circumstances for the activities, omissions or conduct of any owner or operator of any other Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. Italiano | View medication policies and pre-authorization requirements. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. In the case of an emergency, you do not need prior authorization. | 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). In Indiana: Anthem Insurance Companies, Inc. If you receive services that are not medically necessary from one of Blue Cross of Idahos contracting providers without getting prior authorization and payment for the services is denied, you are not financially responsible. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. They may request or review medical records, test results and other information so they understand what services are being performed and are able to make an informed decision. Franais | More prior authorization resources Sign in to Availity 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. This tool is for outpatient services only. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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. Typically, we complete this review within two business days, and notify you and your provider of our decision. Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. Out-of-area providers To stay covered, Medicaid members will need to take action. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for In Indiana: Anthem Insurance Companies, Inc. Do you offer telehealth services? 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. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. Some procedures may also receive instant approval. Complete all member information fields on this form: Complete either the denial or the termination information section. In Ohio: Community Insurance Company. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content FEP utilizes Magellan Rx Management for medical, Providers requesting prior approval for an ASE/PSE member should use the appropriate form on the, Providers who are requesting a prior approval for Walmart or other BlueAdvantage members should use the appropriate form from the, Providers who are requesting a prior approval for BlueMedicare or Health Advantage Medicare Advantage members should use the appropriate form from, Providers requesting prior approval for Part B drugs for BlueMedicare or Health Advantage Medicare should use the, Name and telephone number of contact person, Requesting / Performing Providers NPI or Provider ID, Copy of members insurance card (front/back), CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable, Please use the most descriptive procedure and diagnosis codes, Medical records to support requested services. 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. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. 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. No, the need for emergency services does not require prior authorization. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Do not sell or share my personal information. Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, | URAC Accredited - Health Plan with Health Insurance Marketplace (HIM) - 7.3, URAC Accredited - Health Utilization Management - 7.4, Member forms - Individual and family plans, Coverage policy and pre-certification/pre-authorization, Approval information for radiological services, Medicare Advantage Prior Authorization Request Form, Part B Medication Prior Approval Request Form, Check deductible and out-of-pocket totals. 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. Check whether a prior authorization is needed Check the status of a prior authorization This information is also available in other ways to people with disabilities by calling customer service at (651) 662-8000 (voice), or 1-800-382-2000 (toll free). Administrative. Use Availity to submit prior authorizations and check codes. Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas. Expand All Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. Step 5 In Medication / Medical and Dispensing Information, specify the medication name and indicate whether or not the request is a new therapy or a renewal (if renewal, specifythe date therapy started and the duration). Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. In Connecticut: Anthem Health Plans, Inc. March 2023 Anthem Provider News - New Hampshire. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Oct 1, 2020 The Blue Cross name and symbol are registered marks of the Blue Cross Association. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. This may result in a delay of our determination response. In the case of a medical emergency, you do not need prior authorization to receive care. Oromoo | FEP Basic Option/Standard OptionFEP Blue Focus. Step 9 At the top of page 2, provide the patients name and ID number. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). Online - The AIM ProviderPortal is available 24x7. Choose your location to get started. 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. Get Started Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. March 2023 Anthem Provider News - Georgia, February 2023 Anthem Provider News - Georgia, New ID cards for Anthem Blue Cross and Blue Shield members - Georgia, Telephonic-only care allowance extended through April 11, 2023 - Georgia, January 2023 Anthem Provider News - Georgia, prior authorization/precertification form, September 2021 Anthem Provider News - Georgia. Please verify benefit coverage prior to rendering services. Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 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 Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. nor state or imply that you should access such website or any services, products or information which 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. Your plan has a list of services that require prior authorization. Independent licensees of the Blue Cross and Blue Shield Association. By filling out the form completely and with as much information as possible, you can be sure we have the information to process your request timely. . 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. In Connecticut: Anthem Health Plans, Inc. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Prior authorization suspension for Anthem Ohio in-network hospital transfers to in-network skilled nursing facilities effective December 20, 2022 to January 15, 2023: Prior authorization suspension - In-network hospital transfers to In-network SNFs . Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). We look forward to working with you to provide quality services to our members. In Indiana: Anthem Insurance Companies, Inc. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in New Hampshire. We currently don't offer resources in your area, but you can select an option below to see information for that state. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. Step 4 In Prescriber Information, specifythe prescribers full name, speciality, and full address. The resources for our providers may differ between states. By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. February 2023 Anthem Provider News - Ohio, New ID cards for Anthem Blue Cross and Blue Shield members - Ohio, Telephonic-only care allowance extended through April 11, 2023 - Ohio, C1764 Event recorder, cardiac (implantable), E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized, E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, 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, L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, L3170 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each, L3310 Lift, elevation, heel and sole, neoprene, per inch, L3332 Lift, elevation, inside shoe, tapered, up to one-half inch, L3580 Ortho shoe add instep Velcro closure, L3610 Transfer of an orthosis from one shoe to another, caliper plate, new, L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing, L3630 Transfer of an orthosis from one shoe to another, solid stirrup, new, L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified, L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf, L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf, L3761 Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf, L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf, L3807 Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise, L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type, L3912 Hand-finger orthosis (HFO), flexion glove with elastic finger control, prefabricated, off-the-shelf, L3913 HFO, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment, L3923 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. If your state isn't listed, check out bcbs.com to find coverage in your area. It looks like you're in . website. In Maine: Anthem Health Plans of Maine, Inc. In Connecticut: Anthem Health Plans, Inc. Sign in to the appropriate website to complete your request. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. 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. If you choose to access other websites from this website, you agree, as a condition of choosing any such Your browser is not supported. You further agree that ABCBS and its Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. PPO outpatient services do not require Pre-Service Review. Kreyl Ayisyen | L3927 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (for example, static or ring type), may include soft interface material, prefabricated, L5301 Below knee, molded socket, shin, SACH foot, endoskeletal system, L5321 Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee, L5645 Addition to lower extremity, below knee (BK), flexible inner socket, external frame, L5649 Addition to lower extremity, ischial containment/narrow M-L socket, L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each, 0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed, 0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. In Maine: Anthem Health Plans of Maine, Inc. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. In Maine: Anthem Health Plans of Maine, Inc. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Other Blue Plans pre-authorization requirements may differ from ours. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Inpatient services and nonparticipating providers always require prior authorization. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. Information about COVID-19 and your insurance coverage. 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. | ), 0480T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Sep 1, 2021 or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Select Auth/Referral Inquiry or Authorizations. 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. Espaol | It looks like you're outside the United States. View tools for submitting prior authorizationsfor Medicare Advantage members. Independent licensees of the Blue Cross and Blue Shield Association. We look forward to working with you to provide quality services to our members. | Ting Vit | Type at least three letters and well start finding suggestions for you. In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. If you have any questions regarding our Utilization Management or Prior Authorization process, please call Customer Service at the number on the back of your identification card and they can answer any general inquiries you may have. With convenience in mind, Care Centers are at the heart of the patient health journey. It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. 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. third-party website link available as an option to you, ABCBS does not in any way endorse any such website, Independent licensees of the Blue Cross and Blue Shield Association. Learn more about electronic authorization. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. Select Auth/Referral Inquiry or Authorizations. L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, L3925 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), non-torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf. 2022 Electronic Forms LLC. Prior Authorization Medication management With input from community physicians, specialty societies, and our Pharmacy & Therapeutics Committee, which includes community physicians and pharmacists from across the state, we design programs to help keep prescription drug coverage affordable. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. An Independent Licensee of the Blue Cross and Blue Shield Association, Summary of Benefits & Coverage Information, Sleep Testing and Therapy & Advanced Imaging, Confirm your specific treatment plan and medical necessity given your diagnosis, Determine if services are eligible for coverage, Assure your claims are processed accurately and timely, Save you from unnecessary medical expenses. Contact 866-773-2884 for authorization regarding treatment. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services. Easily obtain pre-authorization and eligibility information with our tools. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. To learn more read Microsoft's help article. The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. In Kentucky: Anthem Health Plans of Kentucky, Inc. Prior Authorization details for providers outside of WA/AK. 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 approval for requested services - Arkansas Blue Cross and Blue Shield Prior approval for requested services The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. State & Federal / Medicare. 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. 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. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. We're here to work with you, your doctor and the facility so you have the best possible health outcome. Type at least three letters and we will start finding suggestions for you. Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. You can also visit bcbs.com to find resources for other states. The CarelonRx member services telephone number is 833-279-0458. | the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department 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. The formcontains important information regarding the patients medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patients health care plan. Electronic authorizations. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). 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. The site may not work properly. . Portugus | | To request authorizations: From the Availity home page, select Patient Registration from the top navigation.