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Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. 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. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Your dashboard may experience future loading problems if not resolved. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. It may not display this or other websites correctly. This tool is for outpatient services only. Choose your state below so that we can provide you with the most relevant information. Prior Authorization Lookup. 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. Please verify benefit coverage prior to rendering services. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Enter a Current Procedural Terminology (CPT) code in the space below to get started. 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. JavaScript is disabled. 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. 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. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Use the Prior Authorization tool within Availity. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Your dashboard may experience future loading problems if not resolved. Review medical and pharmacy benefits for up to three years. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. Price a medication, find a pharmacy,order auto refills, and more. All other available Medical Policy documents are published by policy/topic title. 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. Plus, you may qualify for financial help to lower your health coverage costs. The resources for our providers may differ between states. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We look forward to working with you to provide quality services to our members. Our resources vary by state. If youre concerned about losing coverage, we can connect you to the right options for you and your family. We currently don't offer resources in your area, but you can select an option below to see information for that state. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. We look forward to working with you to provide quality service for our members. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. 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. Medicaid renewals will start again soon. 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. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). We look forward to working with you to provide quality services to our members. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. The COVID19 pandemic and nationwide shutdown that started in March 2020 placed a spotlight on crisis preparedness within the U.S. hea Dont assume the codes youve been using to report drugs and biologicals still apply. Were committed to supporting you in providing quality care and services to the members in our network. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. In Maine: Anthem Health Plans of Maine, Inc. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). 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. Enter a CPT or HCPCS code in the space below. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. We are also licensed to use MCG guidelines to guide utilization management decisions. Members should contact their local customer service representative for specific coverage information. Explore programs available in your state. Anthem offers great healthcare options for federal employees and their families. The resources for our providers may differ between states. To stay covered, Medicaid members will need to take action. 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. We offer flexible group insurance plans for any size business. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Our resources vary by state. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Our resources vary by state. The tool will tell you if that service needs . Quickly and easily submit out-of-network claims online. Inpatient services and nonparticipating providers always require prior authorization. Find a Medicare plan that fits your healthcare needs and your budget. It does not reflect benefits coverage, nor does it include an exhaustive listing of all non-covered services (in other words, experimental procedures, cosmetic surgery, etc.). In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. 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. Understand your care options ahead of time so you can save time and money. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. Independent licensees of the Blue Cross and Blue Shield Association. This tool is for outpatient services only. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Your online account is a powerful tool for managing every aspect of your health insurance plan. Access your member ID card from our website or mobile app. 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. For subsequent inpatient care, see 99231-99233. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Lets make healthy happen. Inpatient services and non-participating providers always require prior authorization. Type at least three letters and we will start finding suggestions for you. 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). Medicare Complaints, Grievances & Appeals. We look forward to working with you to provide quality service for our members. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. You can also visit bcbs.com to find resources for other states. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). Please update your browser if the service fails to run our website. You can also visit. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. We offer affordable health, dental, and vision coverage to fit your budget. Start by logging onto Availity.com and selecting the Register icon at the top of the home screen or use this link to access the registration page. You can also visit bcbs.com to find resources for other states. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Our call to Anthem resulted in a general statement basically use a different code. Members should discuss the information in the clinical UM guideline with their treating health care providers. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Jan 1, 2020 Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. 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. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Find answers to all your questions with an Anthem representative in real time. In Maine: Anthem Health Plans of Maine, Inc. 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. Pay outstanding doctor bills and track online or in-person payments. Find drug lists, pharmacy program information, and provider resources. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Additional medical policies may be developed from time to time and some may be withdrawn from use. Choose your location to get started. 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. Vaccination is important in fighting against infectious diseases. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Health equity means that everyone has the chance to be their healthiest. If this is your first visit, be sure to check out the. Members should discuss the information in the medical policies with their treating health care professionals. With Codify by AAPC cross-reference tools, you can check common code pairings. New member? 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. Select Auth/Referral Inquiry or Authorizations. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. No provider of outpatient services gets paid without reporting the proper CPT codes. Access resources to help health care professionals do what they do bestcare for our members. Medical policies can be highly technical and complex and are provided here for informational purposes. Please verify benefit coverage prior to rendering services. Please note that services listed as requiring precertification may not be covered benefits for a member. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We currently don't offer resources in your area, but you can select an option below to see information for that state. If you are unsure or have any questions, please be sure to check member eligibility and benefit coverage before proceeding with any authorization requests or services by contacting Provider Services at 800-901-0020. Start a Live Chat with one of our knowledgeable representatives. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Choose your state below so that we can provide you with the most relevant information. It looks like you're in . In Connecticut: Anthem Health Plans, Inc. Our research shows that subscribers using Codify by AAPC are 33% more productive. In Kentucky: Anthem Health Plans of Kentucky, Inc. You can also visit bcbs.com to find resources for other states. Choose your state below so that we can provide you with the most relevant information.