The resources for our providers may differ between states. The resources for our providers may differ between states. It looks like you're outside the United States. Plus, you may qualify for financial help to lower your health coverage costs. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Out-of-state providers. Choose your state below so that we can provide you with the most relevant information. Vaccination is important in fighting against infectious diseases. 711. They are not agents or employees of the Plan. Do not sell or share my personal information. Independent licensees of the Blue Cross and Blue Shield Association. Click Submit. Use our app, Sydney Health, to start a Live Chat. Please verify benefit coverage prior to rendering services. Price a medication, find a pharmacy,order auto refills, and more. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. 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.). Your browser is not supported. 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. 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. State & Federal / Medicaid. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Explore programs available in your state. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. 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. For subsequent inpatient care, see 99231-99233. The resources for our providers may differ between states. Your dashboard may experience future loading problems if not resolved. 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. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. 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. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. 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. The purpose of this communication is the solicitation of insurance. Administrative / Digital Tools, Learn more by attending this live webinar. Access resources to help health care professionals do what they do bestcare for our members. You can also visit. ET. Our research shows that subscribers using Codify by AAPC are 33% more productive. In Ohio: Community Insurance Company. Find a Medicare plan that fits your healthcare needs and your budget. 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 Indiana: Anthem Insurance Companies, Inc. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Please Select Your State The resources on this page are specific to your state. Anthem offers great healthcare options for federal employees and their families. Select Auth/Referral Inquiry or Authorizations. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. 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. Find out if a service needs prior authorization. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. If your state isn't listed, check out bcbs.com to find coverage in your area. 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. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Use the Prior Authorization tool within Availity OR. This tool is for outpatient services only. 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. 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. 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. 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. Our resources vary by state. Medicare Complaints, Grievances & Appeals. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In Connecticut: Anthem Health Plans, Inc. Please verify benefit coverage prior to rendering services. The resources for our providers may differ between states. Use of the Anthem websites constitutes your agreement with our Terms of Use. We look forward to working with you to provide quality services to our members. We are also licensed to use MCG guidelines to guide utilization management decisions. To get started, select the state you live in. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. Inpatient services and non-participating providers always require prior authorization. Medical policies can be highly technical and complex and are provided here for informational purposes. The notices state an overpayment exists and Anthem is requesting a refund. Please verify benefit coverage prior to rendering services. Choose your state below so that we can provide you with the most relevant information. 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. Choose your location to get started. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. Taking time for routine mammograms is an important part of staying healthy. 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. 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. 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. Provider Medical Policies | Anthem.com Find information that's tailored for you. New member? I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. Start a Live Chat with one of our knowledgeable representatives. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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). This tool is for outpatient services only. We look forward to working with you to provide quality service for our members. We currently don't offer resources in your area, but you can select an option below to see information for that state. Choose your location to get started. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Members should contact their local customer service representative for specific coverage information. 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 We currently don't offer resources in your area, but you can select an option below to see information for that state. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Choose your location to get started. 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.) 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. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Copyright 2023. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. 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. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. You are using an out of date browser.