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Your browser is not supported. New member? The resources for our providers may differ between states. Members should discuss the information in the medical policies with their treating health care professionals. Administrative / Digital Tools, Learn more by attending this live webinar. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Members should contact their local customer service representative for specific coverage information. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Please note: This tool is for outpatient services only. Anthem is a registered trademark of Anthem Insurance Companies, Inc. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. The resources on this page are specific to your state. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare, Keyword database enhanced with medical acronyms and terminology, Default settings to lock in your preference for code-centered or range pages, Code Constructor to narrow down your code options one clickable range at a time, Lay terms and CPT code update information, An expanded index by service eases looking for a procedure or service. You can also visit. New member? Inpatient services and nonparticipating providers always require prior authorization. If your state isn't listed, check out bcbs.com to find coverage in your area. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. For costs and complete details of the coverage, please contact your agent or the health plan. You can access the Precertification Lookup Tool through the Availity Portal. We are also licensed to use MCG guidelines to guide utilization management decisions. 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. Plus, you may qualify for financial help to lower your health coverage costs. Your dashboard may experience future loading problems if not resolved. Start a Live Chat with one of our knowledgeable representatives. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. Please verify benefit coverage prior to rendering services. There is no cost for our providers to register or to use any of the digital applications. Prior authorization lookup tool| HealthKeepers, Inc. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. 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. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. 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. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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. 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. We update the Code List to conform to the most recent publications of CPT and HCPCS . Select Auth/Referral Inquiry or Authorizations. Once youve accessed the Precertification Lookup Tool, choose a line of business from the menu selection offered, and then type the CPT/HCPCS code or a code description to determine if a prior authorization is required. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Pay outstanding doctor bills and track online or in-person payments. Inpatient services and nonparticipating providers always require prior authorization. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. We look forward to working with you to provide quality services to our members. Anthem offers great healthcare options for federal employees and their families. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Contact will be made by an insurance agent or insurance company. Click Submit. 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. Choose your location to get started. 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. Our resources vary by state. Please update your browser if the service fails to run our website. 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. * 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. Please note that services listed as requiring precertification may not be covered benefits for a member. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. Please verify benefit coverage prior to rendering services. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. In Ohio: Community Insurance Company. 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. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. 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). Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) State & Federal / Medicaid. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Medicare Complaints, Grievances & Appeals. This tool is for outpatient services only. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Find a Medicare plan that fits your healthcare needs and your budget. It looks like you're outside the United States. You can access the Precertification Lookup Tool through the Availity Portal. Please verify benefit coverage prior to rendering services. Find out if a service needs prior authorization. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. These documents are available to you as a reference when interpreting claim decisions. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. 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. Choose your state below so that we can provide you with the most relevant information. Our research shows that subscribers using Codify by AAPC are 33% more productive. 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. The resources for our providers may differ between states. 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. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. 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. 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. 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Lets make healthy happen. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Reimbursement Policies. We currently don't offer resources in your area, but you can select an option below to see information for that state. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. The tool will tell you if that service needs . The resources for our providers may differ between states. 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. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). There are several factors that impact whether a service or procedure is covered under a members benefit plan. 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. The notices state an overpayment exists and Anthem is requesting a refund. Our call to Anthem resulted in a general statement basically use a different code. Enter a CPT or HCPCS code in the space below. E0731 Conductive garment for Tens 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 They are not agents or employees of the Plan. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Apr 1, 2022 We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. We currently don't offer resources in your area, but you can select an option below to see information for that state. Please Select Your State The resources on this page are specific to your state. 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 affordable health, dental, and vision coverage to fit your budget. If you arent registered to use Availity, signing up is easy and 100% secure. Our resources vary by state. In Connecticut: Anthem Health Plans, Inc. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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. 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. Do not sell or share my personal information. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. Vaccination is important in fighting against infectious diseases. 711. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Inpatient services and non-participating providers always require prior authorization. For subsequent inpatient care, see 99231-99233. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Access eligibility and benefits information on the Availity* Portal OR. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 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. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. 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. Choose your location to get started. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. Select Auth/Referral Inquiry or Authorizations. In Ohio: Community Insurance Company. 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. The resources on this page are specific to your state. Choose your location to get started. In Indiana: Anthem Insurance Companies, Inc. In Maine: Anthem Health Plans of Maine, Inc. Your online account is a powerful tool for managing every aspect of your health insurance plan. If this is your first visit, be sure to check out the. Additional medical policies may be developed from time to time and some may be withdrawn from use. This tool is for outpatient services only. Reaching out to Anthem at least here on our. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Jan 1, 2020 Find drug lists, pharmacy program information, and provider resources. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. We currently don't offer resources in your area, but you can select an option below to see information for that state. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Understand your care options ahead of time so you can save time and money. 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. This tool is for outpatient services only. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. You can also visit bcbs.com to find resources for other states. Your dashboard may experience future loading problems if not resolved. Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Please verify benefit coverage prior to rendering services. Independent licensees of the Blue Cross and Blue Shield Association. ET. If a prior authorization (PA) is required (indicates "yes" or "no") If there are PA conditions; If the service is a covered benefit (indicates "covered" or "not covered") We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). Where is the Precertification Lookup Tool located on Availity? In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. You can also visit. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. We offer flexible group insurance plans for any size business. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Independent licensees of the Blue Cross Association. Access your member ID card from our website or mobile app. 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. 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. Members should discuss the information in the clinical UM guideline with their treating health care providers. We look forward to working with you to provide quality service for our members. 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. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Your browser is not supported. Quickly and easily submit out-of-network claims online. Enter one or more keyword (s) for desired policy or topic. Please update your browser if the service fails to run our website. 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.