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. Our resources vary by state. The purpose of this communication is the solicitation of insurance. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Please note: This tool is for outpatient services only. We currently don't offer resources in your area, but you can select an option below to see information for that state. If youre concerned about losing coverage, we can connect you to the right options for you and your family. Explore our resources. Please Select Your State The resources on this page are specific to your state. The resources for our providers may differ between states. Please verify benefit coverage prior to rendering services. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. In Connecticut: Anthem Health Plans, Inc. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. 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. Enter a CPT or HCPCS code in the space below. We currently don't offer resources in your area, but you can select an option below to see information for that state. The 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. 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. Our resources vary by state. Access eligibility and benefits information on the Availity* Portal OR. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. You can also visit. Our call to Anthem resulted in a general statement basically use a different code. 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. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. You can access the Precertification Lookup Tool through the Availity Portal. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. 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. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. Independent licensees of the Blue Cross and Blue Shield Association. 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.) Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. In Indiana: Anthem Insurance Companies, Inc. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. To get started, select the state you live in. It looks like you're in . In Indiana: Anthem Insurance Companies, Inc. Your dashboard may experience future loading problems if not resolved. It may not display this or other websites correctly. Prior Authorization Lookup. 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. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Administrative / Digital Tools, Learn more by attending this live webinar. We are also licensed to use MCG guidelines to guide utilization management decisions. It looks like you're outside the United States. If your state isn't listed, check out bcbs.com to find coverage in your area. Please update your browser if the service fails to run our website. You can also visit bcbs.com to find resources for other states. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Explore programs available in your state. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Reimbursement Policies. 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") Anthem is a registered trademark of Anthem Insurance Companies, Inc. Prior authorization lookup tool| HealthKeepers, Inc. The resources for our providers may differ between states. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. We offer affordable health, dental, and vision coverage to fit your budget. State & Federal / Medicaid. Out-of-state providers. Understand your care options ahead of time so you can save time and money. We update the Code List to conform to the most recent publications of CPT and HCPCS . Access to the information does not require an Availity role assignment, tax ID or NPI. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. 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. 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. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Members should discuss the information in the clinical UM guideline with their treating health care providers. 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. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. To stay covered, Medicaid members will need to take action. 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. 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. Our research shows that subscribers using Codify by AAPC are 33% more productive. Start a Live Chat with one of our knowledgeable representatives. Or Use the Prior Authorization tool within Availity. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. 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. 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. Review medical and pharmacy benefits for up to three years. Find answers to all your questions with an Anthem representative in real time. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Medical policies can be highly technical and complex and are provided here for informational purposes. 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. Find out if a service needs prior authorization. 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. You can also visit. In Maine: Anthem Health Plans of Maine, Inc. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Select Auth/Referral Inquiry or Authorizations. 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. For a better experience, please enable JavaScript in your browser before proceeding. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. Find drug lists, pharmacy program information, and provider resources. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Please update your browser if the service fails to run our website. 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. These guidelines do not constitute medical advice or medical care. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. The resources on this page are specific to your state. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. New member? 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. Your browser is not supported. You must log in or register to reply here. We currently don't offer resources in your area, but you can select an option below to see information for that 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. In Kentucky: Anthem Health Plans of Kentucky, Inc. The resources for our providers may differ between states. Please verify benefit coverage prior to rendering services. There are several factors that impact whether a service or procedure is covered under a members benefit plan. Audit reveals crisis standards of care fell short during pandemic. This tool is for outpatient services only. There is no cost for our providers to register or to use any of the digital applications. Choose your location to get started. You can also visit bcbs.com to find resources for other states. In Maine: Anthem Health Plans of Maine, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Interested in joining our provider network? Our resources vary by state. Plus, you may qualify for financial help to lower your health coverage costs.