Here you'll find information on the available plans and their benefits. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Inpatient services and nonparticipating providers always require prior authorization. Search by keyword or procedure code for related policy information. Inpatient services and non-participating providers always require prior authorization. The resources for our providers may differ between states. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. 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. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. 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. Available for iOS and Android devices. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. 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. Choose your location to get started. 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. In Indiana: Anthem Insurance Companies, Inc. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Prior authorization lookup tool| HealthKeepers, Inc. We offer flexible group insurance plans for any size business. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Our research shows that subscribers using Codify by AAPC are 33% more productive. Prior authorizations are required for: All non-par providers. 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. We look forward to working with you to provide quality service for our members. Interested in joining our provider network? With Codify by AAPC cross-reference tools, you can check common code pairings. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. We currently don't offer resources in your area, but you can select an option below to see information for that state. We look forward to working with you to provide quality service for our members. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. In Maine: Anthem Health Plans of Maine, Inc. 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. There is no cost for our providers to register or to use any of the digital applications. The resources for our providers may differ between states. Members should discuss the information in the clinical UM guideline with their treating health care providers. 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. 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. Choose your location to get started. Find drug lists, pharmacy program information, and provider resources. Access to the information does not require an Availity role assignment, tax ID or NPI. Your dashboard may experience future loading problems if not resolved. It looks like you're in . 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. While the clinical UM guidelines developed by us are published on this web site, the licensed standard and customized MCG guidelines are proprietary to MCG and are not published on the Internet site. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. If you arent registered to use Availity, signing up is easy and 100% secure. Members should contact their local customer service representative for specific coverage information. JavaScript is disabled. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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). The resources for our providers may differ between states. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. To stay covered, Medicaid members will need to take action. You can also visit bcbs.com to find resources for other states. Our resources vary by state. For a better experience, please enable JavaScript in your browser before proceeding. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Select Auth/Referral Inquiry or Authorizations. Inpatient services and nonparticipating providers always require prior authorization. Reimbursement Policies. 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. Our resources vary by state. It looks like you're outside the United States. In Ohio: Community Insurance Company. 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. Taking time for routine mammograms is an important part of staying healthy. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Please note that services listed as requiring precertification may not be covered benefits for a member. 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. Independent licensees of the Blue Cross Association. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. In Maine: Anthem Health Plans of Maine, Inc. Were committed to supporting you in providing quality care and services to the members in our network. 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. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Directions. It looks like you're in . Explore programs available in your state. Choose your state below so that we can provide you with the most relevant information. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. Use our app, Sydney Health, to start a Live Chat. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. The notices state an overpayment exists and Anthem is requesting a refund. For subsequent inpatient care, see 99231-99233. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Our resources vary by state. Quickly and easily submit out-of-network claims online. We currently don't offer resources in your area, but you can select an option below to see information for that state. Use of the Anthem websites constitutes your agreement with our Terms of Use. Please verify benefit coverage prior to rendering services. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. For costs and complete details of the coverage, please contact your agent or the health plan. Price a medication, find a pharmacy,order auto refills, and more. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. 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. Start a Live Chat with one of our knowledgeable representatives. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare, Keyword database enhanced with medical acronyms and terminology, Default settings to lock in your preference for code-centered or range pages, Code Constructor to narrow down your code options one clickable range at a time, Lay terms and CPT code update information, An expanded index by service eases looking for a procedure or service. Your online account is a powerful tool for managing every aspect of your health insurance plan. Reaching out to Anthem at least here on our. 711. State & Federal / Medicaid. You must log in or register to reply here. Choose your location to get started. Or We currently don't offer resources in your area, but you can select an option below to see information for that state. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. 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. 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. 2005 - 2023 copyright 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Find a Medicare plan that fits your healthcare needs and your budget. These guidelines do not constitute medical advice or medical care. 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. 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. 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. Members should discuss the information in the medical policies with their treating health care professionals. The tool will tell you if that service needs . Please note: This tool is for outpatient services only. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. In Kentucky: Anthem Health Plans of Kentucky, Inc. If your state isn't listed, check out bcbs.com to find coverage in your area. Use of the Anthem websites constitutes your agreement with our Terms of Use. Medical policies can be highly technical and complex and are provided here for informational purposes. Select Auth/Referral Inquiry or Authorizations. All other available Medical Policy documents are published by policy/topic title. Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment, Indiana Medicaid Prior Authorization Requirements List, New Option Available for Indiana Market.
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