Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Quickly and easily submit out-of-network claims online. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. We look forward to working with you to provide quality service for our members. The resources on this page are specific to your state. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Please verify benefit coverage prior to rendering services. Members should discuss the information in the medical policies with their treating health care professionals. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We are also licensed to use MCG guidelines to guide utilization management decisions. Youll also strengthen your appeals with access to quarterly versions since 2011. Explore our resources. Medical policies can be highly technical and complex and are provided here for informational purposes. Click Submit. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. 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. Access eligibility and benefits information on the Availity* Portal OR. Please update your browser if the service fails to run our website. Please note: This tool is for outpatient services only. 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. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. The notices state an overpayment exists and Anthem is requesting a refund. 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. We look forward to working with you to provide quality services to our members. We offer flexible group insurance plans for any size business. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. ET. Your online account is a powerful tool for managing every aspect of your health insurance plan. The resources for our providers may differ between states. Prior authorization lookup tool | Blue Cross MN It looks like you're outside the United States. Prior-Authorization And Pre-Authorization | Anthem.com Anthem is a registered trademark of Anthem Insurance Companies, Inc. Here you'll find information on the available plans and their benefits. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. Anthem offers great healthcare options for federal employees and their families. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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. Reimbursement Policies. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Audit reveals crisis standards of care fell short during pandemic. No provider of outpatient services gets paid without reporting the proper CPT codes. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Understand your care options ahead of time so you can save time and money. The resources for our providers may differ between states. Select Auth/Referral Inquiry or Authorizations. Select Auth/Referral Inquiry or Authorizations. Choose your state below so that we can provide you with the most relevant information. Choose your location to get started. Access your member ID card from our website or mobile app. Provider Medical Policies | Anthem.com Find information that's tailored for you. The resources on this page are specific to your state. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Please update your browser if the service fails to run our website. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. 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. These documents are available to you as a reference when interpreting claim decisions. We want to help physicians, facilities and other health care professionals submit claims accurately. Price a medication, find a pharmacy,order auto refills, and more. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. We currently don't offer resources in your area, but you can select an option below to see information for that state. Access resources to help health care professionals do what they do bestcare for our members. In Ohio: Community Insurance Company. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. Please note that services listed as requiring precertification may not be covered benefits for a member. A group NPI cannot be used as ordering NPI on a Medicare claim. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. We look forward to working with you to provide quality services to our members. For costs and complete details of the coverage, please contact your agent or the health plan. 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. Inpatient services and nonparticipating providers always require prior authorization. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. 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. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Start a Live Chat with one of our knowledgeable representatives. Choose your location to get started. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. 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 look forward to working with you to provide quality service for our members. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. Understand your care options ahead of time so you can save time and money. Do not sell or share my personal information. We currently don't offer resources in your area, but you can select an option below to see information for that state. If your state isn't listed, check out bcbs.com to find coverage in your area. To get started, select the state you live in. We update the Code List to conform to the most recent publications of CPT and HCPCS . Our resources vary by state. There is no cost for our providers to register or to use any of the digital applications. Future updates regarding COVID-19 will appear in the monthly Provider News publication. In Maine: Anthem Health Plans of Maine, Inc. Provider Reimbursement Policies | Anthem.com We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. We look forward to working with you to provide quality service for our members. 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. Out-of-state providers. 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. 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. CPT Code Lookup, CPT Codes and Search - Codify by AAPC They are not agents or employees of the Plan. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). The resources for our providers may differ between states. Search by keyword or procedure code for related policy information. We offer affordable health, dental, and vision coverage to fit your budget. The Precertification Lookup Tool will let you know if clinical edits apply, information such as the medical necessity criteria used in making the authorization decision, and if a vendor is used -- without the need to make a phone call. For a better experience, please enable JavaScript in your browser before proceeding. The tool will tell you if that service needs . 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") Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. Our resources vary by state. Find answers to all your questions with an Anthem representative in real time. Your browser is not supported. Provider Communications In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Members should discuss the information in the clinical UM guideline with their treating health care providers. Members should contact their local customer service representative for specific coverage information. You can also visit bcbs.com to find resources for other states. Copyright 2023. You must log in or register to reply here. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. 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. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. The resources for our providers may differ between states. Procedure Code Lookup Tool - Washington State Local Health Insurance 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. 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.