anthem blue cross prior authorization list

| Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Complete all member information fields on this form: Complete either the denial or the termination information section. Step 9 At the top of page 2, provide the patients name and ID number. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. Check whether a prior authorization is needed Check the status of a prior authorization This information is also available in other ways to people with disabilities by calling customer service at (651) 662-8000 (voice), or 1-800-382-2000 (toll free). Sep 1, 2021 View the FEP-specific code list and forms. Find care, claims & more with our new app. Please verify benefit coverage prior to rendering services. Deutsch | Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. In Kentucky: Anthem Health Plans of Kentucky, Inc. ), 0480T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure. 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. Kreyl Ayisyen | Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. Step 1 At the top of the form, supply the plan/medical group name, plan/medical group phone number, and plan/medical group fax number. Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. Learn more about electronic authorization. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services. 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. In Ohio: Community Insurance Company. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). 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. The CarelonRx member services telephone number is 833-279-0458. L3927 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (for example, static or ring type), may include soft interface material, prefabricated, L5301 Below knee, molded socket, shin, SACH foot, endoskeletal system, L5321 Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee, L5645 Addition to lower extremity, below knee (BK), flexible inner socket, external frame, L5649 Addition to lower extremity, ischial containment/narrow M-L socket, L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each, 0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed, 0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure. In Connecticut: Anthem Health Plans, Inc. In the event of an emergency, members may access emergency services 24/7. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. Medical Policy and Clinical Guideline updates are available on our provider website, AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List update, Enhancing Provider News website and email communications, Helping to reduce delays when submitting attachments: Make sure your correspondence includes one of these elements, Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines, Specialty pharmacy updates - February 2023, City of Manchester Offers Medicare Advantage Option - New Hampshire, Name change announcement: myNEXUS will transition to Carelon Post Acute Solutions on March 1, 2023, 2023 FEP benefit information available online, Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list (Fylnetra), Telephonic-only care allowance extended through April 11, 2023, Anthem Blue Cross and Blue Shield local precertification change in New Hampshire, Updates to AIM Specialty Health Radiation Oncology Clinical Appropriateness Guidelines, New specialty pharmacy medical step therapy requirements, Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list, Notification regarding reimbursement changes to COVID-19 laboratory services codes, Submitting prior authorizations digitally through Interactive Care Reviewer, Outpatient facility revenue code billing requirements, AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT code list update, Update: AIM Specialty Health Cardiology Clinical Appropriateness Guidelines CPT Code List, Updates to AIM Specialty Health Rehabilitative and Habilitative Services Clinical Appropriateness Guidelines, Updates to AIM Specialty Health Musculoskeletal - Interventional Pain Management Clinical Appropriateness Guidelines, Updates to AIM Specialty Health Cardiac Clinical Appropriateness Guidelines - Material adverse change, Medical policy and clinical guideline updates available on our provider website, Federal Employee Program observation conversion for musculoskeletal cases, Remittance advice message enhancements: Providing clear descriptions and actionable next steps, Childhood Immunization Status and Lead Screening in Children for HEDIS, Attention lab providers: COVID-19 update regarding reimbursement, December 2022 Provider Newsletter - New Hampshire, Important information about utilization management, IngenioRx will become CarelonRx on January 1, 2023, Reimbursement policy retirement: Acupuncture Billed with Evaluation and Management - Professional, Reimbursement policy update: Treatment Rooms with Office Evaluation and Management Services - Facility, Reimbursement policy update: Bundled Services and Supplies - Professional, Manchester School District in New Hampshire moves to the Medicare Advantage plan with Anthem Blue Cross and Blue Shield, 2023 Medicare Advantage service area and benefit updates, Signature requirements for laboratory orders or requisitions, Reminder - updated AIM Musculoskeletal program effective January 1, 2023 - site of care reviews, Specialty pharmacy updates - December 2022, AIM Specialty Health Genetic Testing Clinical Appropriateness Guidelines CPT Code List update, Member assessment of PCP after-hours messaging in 2022, Members assessment of behavioral healthcare after-hours messaging in 2022, CAA: Timely updates help keep our provider directories current, Clinical practice and preventive health guidelines available on anthem.com, Pharmacy information available on the provider website, PCP searches in Find Care - New Hampshire, Support documentation for AIM prior authorization requests, November 2022 Provider Newsletter - New Hampshire, Claims status message enhancements: providing clear descriptions and actionable next steps, Submit digital attachments within seven-calendar days for claims filed with a PWK segment indicator, You can now submit one electronic claim dispute for multiple claims and access correspondence digitally, too, Visit the Provider Learning Hub to view our latest learning opportunities, Correction to reimbursement policy: Place of Service - Facility, Transition to AIM Specialty Health Perirectal Hydrogel Spacer for Prostate Radiotherapy Clinical Appropriateness Guideline, Medical policy and clinical guideline updates available on anthem.com, Medical drug benefit Clinical Criteria updates, Post office boxes being retired because of low usage, Specialty pharmacy updates - November 2022, CAA: Keep your provider directory information up to date, Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022, COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022, Register for our upcoming CME webinar about low back pain management, CME webinar about low back pain management - New Hampshire, October 2022 Provider Newsletter - New Hampshire. 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. You can find the number on the back of your ID card, or you can write to us at the following address: Appeals and Grievance CoordinatorBlue Cross of IdahoPO Box 7408Boise, ID 83707. 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. Prior authorization is not a guarantee of payment. In Ohio: Community Insurance Company. | Oct 1, 2020 Arkansas Blue Cross and Blue Shield is an Independent Licensee of the Blue Cross and Blue Shield Association and is licensed to offer health plans in all 75 counties of Arkansas. Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Let us know! We currently don't offer resources in your area, but you can select an option below to see information for that state. Prior Authorization Medication management With input from community physicians, specialty societies, and our Pharmacy & Therapeutics Committee, which includes community physicians and pharmacists from across the state, we design programs to help keep prescription drug coverage affordable. In Ohio: Community Insurance Company. 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. With convenience in mind, Care Centers are at the heart of the patient health journey. Sign in to the appropriate website to complete your request. More prior authorization resources Sign in to Availity It looks like you're outside the United States. Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. | This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Register today for the Advancing Mental Health Equity for Youth & Young Adults forum hosted by Anthem Blue Cross and Blue Shield (Anthem) and Motivo* for Anthem providers on March 15, 2023. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Please refer to the criteria listed below for genetic testing. 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. 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. of all such websites. Future updates regarding COVID-19 will appear in the monthly Provider News publication. An Independent Licensee of the Blue Cross and Blue Shield Association, Summary of Benefits & Coverage Information, Sleep Testing and Therapy & Advanced Imaging, Confirm your specific treatment plan and medical necessity given your diagnosis, Determine if services are eligible for coverage, Assure your claims are processed accurately and timely, Save you from unnecessary medical expenses. In Ohio: Community Insurance Company. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, Inpatient services and nonparticipating providers always require prior authorization. website. Independent licensees of the Blue Cross and Blue Shield Association. In Indiana: Anthem Insurance Companies, Inc. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing.