The medical policies do not constitute medical advice or medical care. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant 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. Jan 1, 2020 The resources on this page are specific to your state. Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. In Indiana: Anthem Insurance Companies, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. We look forward to working with you to provide quality service for our members. It looks like you're in . Please update your browser if the service fails to run our website. You can also visit. 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. Independent licensees of the Blue Cross Association. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. We look forward to working with you to provide quality services to our members. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. Our call to Anthem resulted in a general statement basically use a different code. 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. Our resources vary by state. Provider Medical Policies | Anthem.com Find information that's tailored for you. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. This tool is for outpatient services only. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. We want to help physicians, facilities and other health care professionals submit claims accurately. Use the Prior Authorization tool within Availity. 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. We look forward to working with you to provide quality service for our members. Please update your browser if the service fails to run our website. Inpatient services and non-participating providers always require prior authorization. These guidelines do not constitute medical advice or medical care. In Maine: Anthem Health Plans of Maine, Inc. Use the Prior Authorization Lookup Tool within Availity or Contact the Customer Care Center: Outside Los Angeles County: 1-800-407-4627 Inside Los Angeles County: 1-888-285-7801 Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-224-0336. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Use of the Anthem websites constitutes your agreement with our Terms of Use. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. We offer flexible group insurance plans for any size business. Inpatient services and non-participating providers always require prior authorization. They are not agents or employees of the Plan. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. 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. You can access the Precertification Lookup Tool through the Availity Portal. 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We currently don't offer resources in your area, but you can select an option below to see information for that state. You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed. The resources for our providers may differ between states. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. Were committed to supporting you in providing quality care and services to the members in our network. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Inpatient services and non-participating providers always require prior authorization. Inpatient services and nonparticipating providers always require prior authorization. Choose your location to get started. Call our Customer Service number, (TTY: 711). Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. In Connecticut: Anthem Health Plans, Inc. Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. You can also visit bcbs.com to find resources for other states. This tool is for outpatient services only. Our research shows that subscribers using Codify by AAPC are 33% more productive. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. 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. Use our app, Sydney Health, to start a Live Chat. For subsequent inpatient care, see 99231-99233. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Price a medication, find a pharmacy,order auto refills, and more. 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. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. A group NPI cannot be used as ordering NPI on a Medicare claim. 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). Anthem is a registered trademark of Anthem Insurance Companies, Inc. While the clinical UM guidelines developed by us are published on this web site, the licensed standard and customized MCG guidelines are proprietary to MCG and are not published on the Internet site. Use the Prior Authorization tool within Availity OR. Please update your browser if the service fails to run our website. There is no cost for our providers to register or to use any of the digital applications. We look forward to working with you to provide quality services to our members. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. Search by keyword or procedure code for related policy information. Members should contact their local customer service representative for specific coverage information. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Choose your location to get started. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. We currently don't offer resources in your area, but you can select an option below to see information for that state. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. Directions. Find answers to all your questions with an Anthem representative in real time. Select Auth/Referral Inquiry or Authorizations. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Please verify benefit coverage prior to rendering services. Or 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. 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. Anthem offers great healthcare options for federal employees and their families. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. You can also visit bcbs.com to find resources for other states. This tool is for outpatient services only. Lets make healthy happen. Not connected with or endorsed by the U.S. Government or the federal Medicare program. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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 also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). 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. To get started, select the state you live in. The resources for our providers may differ between states. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. 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. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). Medicaid renewals will start again soon. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. You can also visit bcbs.com to find resources for other states. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Your dashboard may experience future loading problems if not resolved. 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). We currently don't offer resources in your area, but you can select an option below to see information for that state. Here you'll find information on the available plans and their benefits. The resources for our providers may differ between states. Please verify benefit coverage prior to rendering 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. New member? 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. 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. It looks like you're outside the United States. Please verify benefit coverage prior to rendering services. Enter one or more keyword (s) for desired policy or topic. 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. You can also type part of the code's description to search, for example type "tonsil" to find "Removal of tonsils." This tool can be used to check if a prior authorization is required for health care services covered by Blue Cross and Blue Shield of Minnesota commercial health plans, Medicare Advantage and Platinum Blue. Compare plans available in your area and apply today. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. 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. All other available Medical Policy documents are published by policy/topic title. The tool will tell you if that service needs . You can also visit. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services. Available for iOS and Android devices. Find a Medicare plan that fits your healthcare needs and your budget. Large Group This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. 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. You are using an out of date browser. To stay covered, Medicaid members will need to take action. 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. Choose your state below so that we can provide you with the most relevant information. We update the Code List to conform to the most recent publications of CPT and HCPCS . For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. We currently don't offer resources in your area, but you can select an option below to see information for that state. Call Provider Services at 1-800-454-3730 (TTY 711) After hours, verify member eligibility by calling the 24/7 Nurse HelpLine at 1-800-600-4441. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Click Submit. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Make your mental health a priority. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Select Auth/Referral Inquiry or Authorizations. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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.). Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. For a better experience, please enable JavaScript in your browser before proceeding. Plus, you may qualify for financial help to lower your health coverage costs. Choose your location to get started. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. You must log in or register to reply here. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. It may not display this or other websites correctly. Out-of-state providers. In Ohio: Community Insurance Company. Quickly and easily submit out-of-network claims online. In Indiana: Anthem Insurance Companies, Inc. Prior Authorization Lookup. Your online account is a powerful tool for managing every aspect of your health insurance plan. Please verify benefit coverage prior to rendering services. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. 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. Members should contact their local customer service representative for specific coverage information. Medical policy does not constitute plan authorization, nor is it an explanation of benefits.