Our resources vary by state. Anthem offers great healthcare options for federal employees and their families. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Provider Medical Policies | Anthem.com Find information that's tailored for you. We are also licensed to use MCG guidelines to guide utilization management decisions. In Kentucky: Anthem Health Plans of Kentucky, Inc. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Our resources vary by state. Available for iOS and Android devices. To stay covered, Medicaid members will need to take action. 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. Prior authorization lookup tool| HealthKeepers, 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. 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. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Use our app, Sydney Health, to start a Live Chat. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. Administrative / Digital Tools, Learn more by attending this live webinar. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. Choose your state below so that we can provide you with the most relevant information. Contact will be made by an insurance agent or insurance company. Choose your location to get started. Use the Prior Authorization tool within Availity. We currently don't offer resources in your area, but you can select an option below to see information for that state. Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. All other available Medical Policy documents are published by policy/topic title. You can also visit bcbs.com to find resources for other states. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. 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 tool will tell you if that service needs . Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Plus, you may qualify for financial help to lower your health coverage costs. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Type at least three letters and we will start finding suggestions for you. We currently don't offer resources in your area, but you can select an option below to see information for that state. Medicaid renewals will start again soon. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. We look forward to working with you to provide quality services to our members. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. We currently don't offer resources in your area, but you can select an option below to see information for that state. Your dashboard may experience future loading problems if not resolved. 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. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. 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. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Jan 1, 2020 Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans 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. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. We offer affordable health, dental, and vision coverage to fit your budget. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Find a Medicare plan that fits your healthcare needs and your budget. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. 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. Our resources vary by state. Enter a CPT or HCPCS code in the space below. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. You can also visit. The resources on this page are specific to your state. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. Select Auth/Referral Inquiry or Authorizations. Inpatient services and nonparticipating providers always require prior authorization. Other ways to access: If you are currently accessing the Pre-certification / Pre-Authorization Requirements list through your health plans public website, this option is still available for you. Copyright 2023. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). This tool is for outpatient services only. Lets make healthy happen. Our resources vary by state. 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. You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed. 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. Please verify benefit coverage prior to rendering services. Large Group 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. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Your browser is not supported. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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 services to our members. Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. Members should contact their local customer service representative for specific coverage information. We currently don't offer resources in your area, but you can select an option below to see information for that state. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Audit reveals crisis standards of care fell short during pandemic. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. We currently don't offer resources in your area, but you can select an option below to see information for that state. You can also visit bcbs.com to find resources for other states. The resources for our providers may differ between states. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Understand your care options ahead of time so you can save time and money. Inpatient services and non-participating providers always require prior authorization. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. 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. Directions. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. It looks like you're in . Your dashboard may experience future loading problems if not resolved. 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. 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. For subsequent inpatient care, see 99231-99233. Inpatient services and non-participating providers always require prior authorization. In Kentucky: Anthem Health Plans of Kentucky, Inc. Members should discuss the information in the medical policies with their treating health care professionals.

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