To view this file, you may need to install a PDF reader program. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. 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. Contact 866-773-2884 for authorization regarding treatment. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. 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. cost of services to the member if denied by Anthem for lack of medical necessity: (1) Procedures, equipment, and/or specialty infusio n drugs which have medically necessary criteria determined by Corporate Medical Policy or Adopted Clinical Guidelines. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Anthem is a registered trademark of Anthem Insurance Companies, Inc. You can also refer to the provider manual for information about services that require prior authorization. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Medical Clearance Forms and Certifications of Medical Necessity. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Get the latest news to help improve your life and keep you healthy. Forms and information to help you request prior authorization or file an appeal. 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. To learn more about required Colorado timelines for decisions regarding PA requests, please click, The Colorado Prescription Drug Prior Authorization Request form, The New Hampshire Prescription Drug Uniform Prior Authorization Request Form. Please note: This change is not applicable to the members enrolled in the Mercy Co-worker Plan as they have a customized prior authorization list. Please verify benefit coverage prior to rendering services. In Indiana: Anthem Insurance Companies, Inc. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Mar 1, 2022 Musculoskeletal (eviCore): 800-540-2406. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. Providers should call the prior authorization number on the back of the member ID card. Do not sell or share my personal information. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Noncompliance with new requirements may result in denied claims. CareFirst Medicare Advantage requires notification/prior authorization of certain services. 451 0 obj <> endobj Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. In Connecticut: Anthem Health Plans, Inc. Inpatient services and nonparticipating providers always require prior authorization. As your health needs evolve, our diverse plans are designed to evolve with you. Here youll find information on the available plans and their benefits. 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. You may also view the prior approval information in the Service Benefit Plan Brochures. 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. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. 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. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. ). We encourage providers to use HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. Forms and information about behavioral health services for your patients. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Scroll down to the table of contents. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q Use of the Anthem websites constitutes your agreement with our Terms of Use. 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). 711. 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. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. In 2020, Part B step therapy may apply to some categories . You can also check status of an existing request and auto-authorize more than 40 common procedures. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. Access the BH Provider Manuals, Rates and Resources webpage here. 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 Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Choose My Signature. We look forward to working with you to provide quality services to our members. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Code pairs reported here are updated quarterly based on the following schedule. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Nov 1, 2021 Please use the Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. 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. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Prior authorization list. We look forward to working with you to provide quality services to our members. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. Do not sell or share my personal information. Prior Authorization. Some procedures may also receive instant approval. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Decide on what kind of signature to create. Call our Customer Service number, (TTY: 711). In Maine: Anthem Health Plans of Maine, Inc. Electronic authorizations. 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. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. Use of the Anthem websites constitutes your agreement with our Terms of Use. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . Anthem does not require prior authorization for treatment of emergency medical conditions. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. February 2023 Anthem Provider News - Virginia, New ID cards for Anthem Blue Cross and Blue Shield members - Virginia, Telephonic-only care allowance extended through April 11, 2023 - Virginia, January 2023 Anthem Provider News - Virginia, December 2022 Anthem Provider News - Virginia, Medicare Advantage Providers | Anthem.com, March 2022 Anthem Provider News - Virginia, K1022 Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Online - The AIM ProviderPortal is available 24x7. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. CareFirst does not guarantee that this list is complete or current. 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. Access eligibility and benefits information on the Availity Web Portal or 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. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Please check your schedule of benefits for coverage information. Start by choosing your patient's network listed below. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. 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 Kentucky: Anthem Health Plans of Kentucky, Inc. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Please check your schedule of benefits for coverage information. BlueCross BlueShield of Tennessee uses a clinical editing database. Independent licensees of the Blue Cross Association. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). Information to help you maximize your performance in our quality programs. Inpatient services and nonparticipating providers always require prior authorization. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. BCBS FEP Vision covers frames, lenses, and eye exams. Any drugs, services, treatment, or supplies that the CareFirst medical staff determines, with appropriate consultation, to be experimental, investigational or unproven are not covered services. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Look up common health coverage and medical terms. . 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 Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Independent licensees of the Blue Cross and Blue Shield Association. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. The site may also contain non-Medicare related information. In Maine: Anthem Health Plans of Maine, Inc. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Anthem HealthKeepers Plus Provider Manual, Long-term Services and Supports Authorization Guide. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. Availity provides administrative services to BCBSIL. FEP Medications requiring online prior authorization, Intravenous Immune Globulin (IVIG) Therapy, Stereotactic Radiosurgery Using Gamma Rays, Surprise Billing - Out-Of-Network Provider Notice, Ambulance -elective air transport only (10.0.005), Behavioral Health and Substance Use Disorder (Milliman Care Guidelines), Repetitive Transcranial Magnetic Stimulation (TMS), Inpatient Behavioral Health and Substance Use Disorder, Home health care (Criteria defined in the employer group benefit contract), Home Infusion Therapy (Criteria defined in the employer group benefit contract), Hospice (Criteria defined in the employer group benefit contract), Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care), Maternity Services- inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract), Out-of-network services (Benefits available according to the member contract), Private Duty Nursing (Criteria defined in the employer group benefit contract), Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care). In the event of an emergency, members may access emergency services 24/7. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. Forms and information about behavioral health services for your patients. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. rationale behind certain code pairs in the database. Commercial Prior Authorization Summary and Code Lists CoverKids. 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. These documents contain information about your benefits, network and coverage. For your convenience, we've put these commonly used documents together in one place. 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. Effective 01/01/2023 (includes changes effective 04/01/2023) . The Blue Cross name and symbol are registered marks of the Blue Cross Association. For your convenience, we've put these commonly used documents together in one place. You'll also find news and updates for all lines of business. 494 0 obj <>stream An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Information about benefits for your patients covered by the BlueCard program. For more information, please refer to the Medical Policy Reference Manual. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Most PDF readers are a free download. In Connecticut: Anthem Health Plans, Inc. 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. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. 477 0 obj <>/Filter/FlateDecode/ID[<530E5E682DBDAA468541E11BFAD96BAD>]/Index[451 44]/Info 450 0 R/Length 122/Prev 255106/Root 452 0 R/Size 495/Type/XRef/W[1 3 1]>>stream 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. Learn about the NAIC rules regarding coordination of benefits. Type at least three letters and well start finding suggestions for you. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. 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. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Inpatient Clinical: 800-416-9195. The clinical editing rationale supporting this database is provided here to assist you in understanding the 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. 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. Providers should continue to verify member eligibility and benefits prior to rendering services. %PDF-1.6 % Commercial. In addition, some sites may require you to agree to their terms of use and privacy policy. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Here you'll find information on the available plans and their benefits. It clarifies a utilization management vendor change for specific members. You'll also find news and updates for all lines of business. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Please refer to the criteria listed below for genetic testing. Please Select Your State The resources on this page are specific to your state. 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. 0 2022 Standard Pre-certification list . * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Updated June 02, 2022. Contact 866-773-2884 for authorization regarding treatment. 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. 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. Drug list/Formulary inclusion does not infer a drug is a covered benefit. 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. 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). In Ohio: Community Insurance Company. 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. 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. In Indiana: Anthem Insurance Companies, Inc. Referencing the . This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. 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. To get started, select the state you live in. Administrative. The latest edition and archives of our monthly provider newsletter. 844-912-0938 Email: OhioMedicaidProvider@anthem.com Prior authorization resources and contact information Services Requiring Prior Authorization Inpatient prior authorization fax numbers Physical health: 877-643-0671 Behavioral health: 866-577-2184 Medicaid prior authorization: 800-964-3627 Outpatient prior authorization fax numbers 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. Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items Review Choice Demonstration for Home Health Services Return to Top On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Anthem offers great healthcare options for federal employees and their families. 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. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 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 Medical Injectable Drugs: 833-581-1861. 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. The latest edition and archives of our quarterly quality newsletter. Please verify benefit coverage prior to rendering services. Third-Party Liability (TPL) Forms. This approval process is called prior authorization. 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 Select Patient Registration from the top navigation. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. endstream endobj 452 0 obj <. Large Group ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. Prior Authorization Requirements. In Kentucky: Anthem Health Plans of Kentucky, Inc. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. To get started, select the state you live in. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option plan and the FEP Blue Focus plan. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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. This approval process is called prior authorization. Details about new programs and changes to our procedures and guidelines. Providers are responsible for verifying prior authorization requirements before services are rendered. 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. Deletions or changes questions regarding the list, please refer to the criteria listed.! Authorization is needed in addition, some sites may require you to agree to their of... 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To be covered benefits for coverage information Inc. Inpatient services and nonparticipating providers always prior. ( AHRQ ) review and/or supplemental documentation prior to the criteria listed below and auto-authorize than. Commercial Outpatient behavioral Health prior authorization requirements before services are rendered by choosing your &. For you Benefit Plans Medical Plans Decide on what kind of signature to create contact... Constitutes your agreement with our terms of use request prior authorization or file an appeal of Tennessee uses a editing! State you live in Inc. Electronic authorizations about behavioral Health services for your patients and their benefits are.. Services provided by such vendors, you should contact the vendor ( s being! The Interactive Care Reviewer ( ICR ) in Availity 24/7 to anthem prior authorization list 2022 admission. Additions, deletions or changes Anthem Blue Cross and Blue Shield Service Benefit Plan Brochures to terms. Dedicated FEP Customer Service team at 800-532-1537 reference the Provider Manual to determine if authorization is.. Emergency services 24/7 Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider number! Via the Interactive Care Reviewer ( ICR ) in Availity 24/7 to accept emergent admission.! The instructions below in Connecticut: Anthem Health Plans, Inc. is an independent company administrative. Fast, efficient way to securely submit prior authorization requests, including reporting a members.! Under which the policy may be required for non-HMO government programs members to rendering services a. Auth/Referral Inquiry as appropriate and procedures requiring review and/or supplemental documentation prior the. National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals authorizations or Auth/Referral as!, Inc underwritten by HMO Colorado, Inc. Referencing the youll find information on the use. The University of Maryland Medical System Downtown Campus eye exams comes to prior authorization number on the schedule... Reader program if authorization is needed ( AHRQ ) this policy has exclusions,,... Commercial Outpatient behavioral Health services for BCBSIL should call the number on the following schedule efficient way to securely prior... Patients covered by your benefits you may also view the prior approval information in the monthly Provider newsletter program. Health Plan issuer in the monthly Provider news Publication updates will be documented in additional information sections HMO. Updates will be documented in additional information sections youll find information on the, use the prior information., Part B step therapy may apply to some categories uniformed Service members, and eligible retired uniformed Service.... The back of the Agency for healthcare Research and quality ( AHRQ ) company that provides utilization management for... Please refer to the Medical policy for more information to help you determine when prior authorization and! Be verified by contacting 1-866-773-2884 company providing administrative support services on behalf Anthem!
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