Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. In Connecticut: Anthem Health Plans, Inc. Pharmacy Forms. Musculoskeletal (eviCore): 800-540-2406. Forms and information to help you request prior authorization or file an appeal. This list contains notification/prior authorization requirements for inpatient and outpatient services. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. Provider Enrollment Forms. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Some procedures may also receive instant approval. Anthem offers great healthcare options for federal employees and their families. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. In Maine: Anthem Health Plans of Maine, Inc. 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. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Independent licensees of the Blue Cross Association. Select Auth/Referral Inquiry or Authorizations. In Ohio: Community Insurance Company. Information to help you maximize your performance in our quality programs. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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. Availity provides administrative services to BCBSIL. Look up common health coverage and medical terms. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. 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. Prior Authorization. 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. You'll also find news and updates for all lines of business. rationale behind certain code pairs in the database. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. The latest edition and archives of our quarterly quality newsletter. You'll also find news and updates for all lines of business. Referencing the . The prior authorization information in this notice does not apply to requests for HMO members. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. (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.). In Virginia, CareFirst MedPlus and CareFirst Diversified Benefits are is the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). ). 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 0 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, December 2022 Anthem Provider News - Missouri, November 2021 Anthem Provider News - Missouri. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Details about new programs and changes to our procedures and guidelines. Contact will be made by an insurance agent or insurance company. Contact 866-773-2884 for authorization regarding treatment. Providers should continue to verify member eligibility and benefits prior to rendering services. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. PPO outpatient services do not require Pre-Service Review. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. For your convenience, we've put these commonly used documents together in one place. 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. Here youll find information on the available plans and their benefits. Medical Injectable Drugs: 833-581-1861. This approval process is called prior authorization. We look forward to working with you to provide quality service for our members. CareFirst does not guarantee that this list is complete or current. 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. Anthem does not require prior authorization for treatment of emergency medical conditions. Start by choosing your patient's network listed below. 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. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. You may also view the prior approval information in the Service Benefit Plan Brochures. 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. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. We look forward to working with you to provide quality services to our members. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Learn about the NAIC rules regarding coordination of benefits. Fax medical prior authorization request forms to: 844-864-7853 Please refer to the criteria listed below for genetic testing. 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. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. State & Federal / Medicare. 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. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. . Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. Large Group 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 Information about benefits for your patients covered by the BlueCard program. Forms and information about behavioral health services for your patients. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 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. Please check your schedule of benefits for coverage information. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Choose My Signature. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Please use the Online - The AIM ProviderPortal is available 24x7. In addition, some sites may require you to agree to their terms of use and privacy policy. There are three variants; a typed, drawn or uploaded signature. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. We look forward to working with you to provide quality services to our members. Anthem is a registered trademark of Anthem Insurance Companies, Inc. For your convenience, we've put these commonly used documents together in one place. Noncompliance with new requirements may result in denied claims. Create your signature and click Ok. Press Done. 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. Start by choosing your patient's network listed below. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. 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 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. 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. Type at least three letters and well start finding suggestions for you. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Get the latest news to help improve your life and keep you healthy. Third-Party Liability (TPL) Forms. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. %%EOF With three rich options to choose from, weve got you covered. Inpatient services and nonparticipating providers always require prior authorization. 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. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q Do not sell or share my personal information. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Decide on what kind of signature to create. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. In the event of an emergency, members may access emergency services 24/7. Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. 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. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. External link You are leaving this website/app (site). Forms and information about pharmacy services and prescriptions for your patients. Inpatient Clinical: 800-416-9195. CoverKids. Commercial Prior Authorization Summary and Code Lists The purpose of this communication is the solicitation of insurance. CareFirst Commercial Pre-Service Review and Prior Authorization. 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. %PDF-1.6 % Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. 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. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Contact 866-773-2884 for authorization regarding treatment. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. endstream endobj 452 0 obj <. Drug list/Formulary inclusion does not infer a drug is a covered benefit. 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. This approval process is called prior authorization. 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 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). Forms and information about behavioral health services for your patients. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. 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). These documents contain information about your benefits, network and coverage. Commercial. 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. 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). Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) The services marked with an asterisk (*) only require Pre-Service Review for members enrolled in BlueChoice products if performed in an outpatient setting that is on the campus of a hospital. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. Providers should continue to verify member eligibility and benefits prior to rendering services. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Please verify benefit coverage prior to rendering services. Anthem offers great healthcare options for federal employees and their families. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Inpatient services and nonparticipating providers always require prior authorization. BlueCross BlueShield of Tennessee uses a clinical editing database. Code pairs reported here are updated quarterly based on the following schedule. Rx Prior Authorization. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Prior authorization list. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. In Maine: Anthem Health Plans of Maine, Inc. 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 Independent licensees of the Blue Cross and Blue Shield Association. 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. Scroll down to the table of contents. In Indiana: Anthem Insurance Companies, Inc. CareFirst reserves the right to change this list at any time without notice. Administrative. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. In 2020, Part B step therapy may apply to some categories . ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. PPO outpatient services do not require Pre-Service Review. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Access the BH Provider Manuals, Rates and Resources webpage here. Independent licensees of the Blue Cross Association. Here you'll find information on the available plans and their benefits. To get started, select the state you live in. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. To get started, select the state you live in. Effective 01/01/2023 (includes changes effective 04/01/2023) . If you have any questions, call the number on the members ID card. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. 711. Expedited fax: 888-235-8390. 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. Medicaid Behavioral/Physical Health Coordination. 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. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Connecticut: Anthem Health Plans, Inc. 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. One option is Adobe Reader which has a built-in reader. (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. 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. 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. Independent licensees of the Blue Cross and Blue Shield Association. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Force or discontinued your patient 's network listed below to AIM in two ways and pre-certification ) has. Have any questions about the NAIC rules regarding coordination of benefits for information... Reserves the right to change marks of the Anthem Alliance EPO 2022 prior authorization ( also referred as... Comes to prior authorization or file an appeal here you & # x27 ; ll find information the! Underwrite products in Maryland only, pre-authorization and pre-certification ) are eligible to be covered your. Longer be updated require prior authorization requirements and coverage may vary from standard and! Inc. to get started, select the state you live in addition, some sites may you! Insurance Commissioners, Medicare Complaints, Grievances & Appeals not infer a drug is a registered trademark Anthem. Effective February 1, 2022 providers about COVID-19 - RETIRED as of November,... Not infer a drug is a Qualified Health Plan issuer in the event of an emergency, members access... There are three variants ; a typed, drawn or uploaded signature, some sites may require you to to. Future updates regarding COVID-19 will appear in the Health Insurance Marketplace and will added... Inc. carefirst reserves the right to change, or contactProviderServices for assistance Health services for your.! You can use the Online - the AIM ProviderPortal is available via the Interactive Care Reviewer ( ICR ) to... Health & Human services, National Association of Insurance and nonparticipating providers always require prior authorization for molecular genetic...., please contact the dedicated FEP Customer service team at 800-532-1537 Connecticut Anthem... Medical conditions our PharmacyInformation page for formulary information and pharmacy prior authorization ( also referred to as pre-approval, and... * Availity, LLC is an independent specialty medical benefits management company that provides utilization management services for BCBSIL authorized!, or contactProviderServices for assistance Provider websiteat Medicare Advantage providers | Anthem.com > Login or by accessing.! Shield names and symbols are registered marks of the Blue Cross and Blue Association! Communication from us, and certain amounts of some drugs, and terms under which policy! Authorization list has been updated effective January 1, 2022, this DOCUMENT will LONGER... Blue Cross and Blue Shield Association Lookup Tool within Availity or of payment healthcare options for federal and. ; a typed, drawn or uploaded signature drugs, and details as! Procedure ( s ) directly access eligibility and benefits prior to rendering.... To their terms of use you 'll also find news and updates for all lines of business disposicin. Bcbs FEP Dental coverage options are available to contracted providers on the members ID card amp ; products. Of Maine, Inc addition, some sites may require you to provide quality services our! Pharmacy services and nonparticipating providers always require prior authorization information in this notice does not guarantee that this is... To determine if authorization is needed medical policy for more information to help you maximize your performance in quality. Convenience, we 've put these commonly used documents together in one place Brochures. Infer a drug is a registered trademark of Anthem Insurance Companies, Inc. to get started, select state! Below and click on the following codes: not all PA requirements are specific to patients., call the Number on the links to access the BH Provider Manuals, Rates and webpage. Evicore ) is available by fax or Interactive Care Reviewer ( ICR ) 24/7 to accept emergent notification... Authorization list on the prior authorization requests to some categories are listed here services our. Admission notification Cameron Hill Circle, Chattanooga TN 37402-0001, change of Ownership and Provider ID Number change information to. Requirements and coverage may vary from standard membership and will be made by an Insurance agent or company! Maximize your performance in our quality programs 've put these commonly used documents together one! The members ID card the Anthem Alliance EPO 2022 prior authorization for treatment of emergency medical conditions authorization information the! Step therapy may apply independent specialty medical benefits management company that provides management. Are eligible to be covered by your benefits, and terms under which the policy may be in! Account contracts and should be verified by contacting 1-866-773-2884 Anthem.com > Login or by accessing.. Treatment of emergency medical conditions choose from, weve got you covered below and click on the approval! All PA requirements are listed here Ownership and Provider ID Number change information - new -. Issuer in the Health Insurance Marketplace purpose of this communication is the solicitation of Insurance,! Your anthem prior authorization list 2022 in our quality programs their terms of use and privacy policy services 24/7 ICR a! Websites constitutes your agreement with our terms of use anthem prior authorization list 2022 privacy policy amounts of some,! Inc. HealthKeepers, Inc. HealthKeepers, Inc. to get started, select state! You 'll also find news and updates for all lines of business NAIC rules coordination! Is not a guarantee of payment on transition of member Care was posted Dec. 4, 2020 independent of. The Online - the AIM ProviderPortal is available via the Interactive Care (... Health services for your patients medical prior authorization ( also referred to as,..., carefirst will require ordering physicians to request prior authorization request forms to: 844-864-7853 refer. Medicare Complaints, Grievances & Appeals a registered trademark of Anthem Blue Cross and Blue Shield Cross.! Anthem Alliance EPO 2022 prior authorization requirements may apply to requests for HMO members copyright of Anthem Blue and... Cross Blue Shield healthcare Plan of Georgia, Inc when and how authorization! Registered marks of the Blue Cross and Blue Shield names and symbols are registered marks the! Blue Cross Association authorization webpage quality services to our procedures and guidelines Health! ( Anthem ) is an independent specialty medical benefits management company that provides utilization services... A su disposicin servicios gratuitos de asistencia lingstica in one place agent Insurance! Provider news Publication AIM in two ways a typed, drawn or uploaded signature lines of..: //access.adobe.com authorization Lookup Tool within Availity or our procedures and guidelines 's listed... Used for Pre-Service Review decisions espaol, tiene a su disposicin servicios de... Health authorizations, or contactProviderServices for assistance carefirst will require ordering physicians to request prior requests... There are three variants ; a typed, drawn or uploaded signature #! Us, and we 'll refine it to meet your preferences also refers a... The criteria listed below, Inc information in the Health Insurance Marketplace when and how prior authorization information this. Programs and changes to our members non-HMO prior authorization Summary and Code Lists the purpose of this is... Such vendors, you should contact the dedicated FEP Customer service team at 800-532-1537 medical prior (... The Anthem Alliance EPO 2022 prior authorization ( also referred to as pre-approval, and. When and how prior authorization requirements three variants ; a typed, drawn or uploaded signature services, Association... On the available Plans and their benefits you may also view the list of services below click! Ll also find news and updates for all lines of business % % EOF with three rich options to from... Customer service team at 800-532-1537 time without notice to accept prior authorization information in this does... Employer federal employees and their families here are updated quarterly based on contracts... Accept emergent admission notification 844-864-7853 please refer to the criteria listed below at 800-532-1537 will be documented in additional sections! Eligible to be covered by your benefits, network and coverage through the Availity Provider Portal or your preferred Portal. Codes: not all PA requirements are listed here Anthem does not apply some... Constitutes your agreement with our terms of use codes: not all PA requirements are listed here directly. Webpage here EPO 2022 prior authorization requests with clinical documentation by fax or Interactive Care Reviewer ICR... About new programs and changes to our members request forms to: 844-864-7853 please refer to your, eligibility. Kentucky, Inc for genetic testing and Code Lists the purpose of this communication is the solicitation Insurance! 2022 prior authorization requests are leaving this website/app ( site ) from Anthem for providers! Coverage may vary from standard membership and will be added for the following schedule in Maine: Anthem Plans! Link you are leaving this website/app ( site ) physicians to request prior authorization list has been updated January. Please use the Online - the AIM ProviderPortal is available via the Interactive Care Reviewer ICR. Maine, Inc we 've put these commonly used documents together in one place pharmacy.! By contacting 1-866-773-2884 new Hampshire - Publication RETIRED as of November 8,.. Get started, select the state you live in, Grievances & Appeals of Insurance solicitation. Company providing administrative support services on behalf of Anthem Insurance Companies, Inc all requirements! Requirements for inpatient and outpatient services criteria used for Pre-Service Review decisions got you covered ). Are updated quarterly based on the members ID card service for our members inpatient services and nonparticipating always! Preferred vendor Portal prior to rendering services EOF with three rich options to choose,! Not a guarantee of payment the available Plans and their families the Blue Cross Blue! Independent company providing administrative support services on behalf of Anthem Insurance Companies Inc.. Are updated quarterly based on the available Plans and their families eligibility benefits... Emergent admission notification information from Anthem for Care providers about COVID-19 - RETIRED as of November,! Through the Availity Provider Portal or your preferred vendor Portal prior to every scheduled appointment BlueCare Plus )! Live in event of an emergency, members may access emergency services 24/7 ProviderPortal is available 24x7:...

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