ABCBS makes no warranties or representations of any kind, express or implied, nor under any circumstances for the activities, omissions or conduct of any owner or operator of any other ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. An Anthem(Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patients prescription cost. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). Independent licensees of the Blue Cross and Blue Shield Association. Please verify benefit coverage prior to rendering services. This form should only be used for Arkansas Blue Cross and Blue Shield members. In Ohio: Community Insurance Company. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Therefore, its important for you to know your benefits and covered services. Ting Vit | If yes, provide the medication name, dosage, duration of therapy, and outcome. If your state isn't listed, check out bcbs.com to find coverage in your area. If you receive services that are not medically necessary from one of Blue Cross of Idahos contracting providers without getting prior authorization and payment for the services is denied, you are not financially responsible. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. Contact 866-773-2884 for authorization regarding treatment. | The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Anthem partners with health care professionals to close gaps in care and improve members overall heath. View the FEP-specific code list and forms. | benefit certificate to determine which services need prior approval. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. In Ohio: Community Insurance Company. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. The site may not work properly. Typically, we complete this review within two business days, and notify you and your provider of our decision. In the event of an emergency, members may access emergency services 24/7. PPO outpatient services do not require Pre-Service Review. Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. We look forward to working with you to provide quality services to our members. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. Franais | third-party website link available as an option to you, ABCBS does not in any way endorse any such website, 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. Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. In Maine: Anthem Health Plans of Maine, Inc. Administrative. | The formcontains important information regarding the patients medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patients health care plan. Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Use Availitys electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. It looks like you're outside the United States. We deliver personalized healthcare the way you want it, where you need it: in our neighborhood Care Centers, in your own home, in hospitals or skilled nursing facilities. Step 5 In Medication / Medical and Dispensing Information, specify the medication name and indicate whether or not the request is a new therapy or a renewal (if renewal, specifythe date therapy started and the duration). Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. Independent licensees of the Blue Cross Association. 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. Review requirements for Medicare Advantage members. 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. 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. Have you reviewed your online provider directory information lately? Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. 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. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. State & Federal / Medicare. Kreyl Ayisyen | February 2023 Anthem Provider News - Ohio, New ID cards for Anthem Blue Cross and Blue Shield members - Ohio, Telephonic-only care allowance extended through April 11, 2023 - Ohio, C1764 Event recorder, cardiac (implantable), E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized, E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, 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, L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, L3170 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each, L3310 Lift, elevation, heel and sole, neoprene, per inch, L3332 Lift, elevation, inside shoe, tapered, up to one-half inch, L3580 Ortho shoe add instep Velcro closure, L3610 Transfer of an orthosis from one shoe to another, caliper plate, new, L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing, L3630 Transfer of an orthosis from one shoe to another, solid stirrup, new, L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified, L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf, L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf, L3761 Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf, L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf, L3807 Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise, L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type, L3912 Hand-finger orthosis (HFO), flexion glove with elastic finger control, prefabricated, off-the-shelf, L3913 HFO, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment, L3923 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. Oromoo | Independent licensees of the Blue Cross and Blue Shield Association. We currently don't offer resources in your area, but you can select an option below to see information for that state. Step 9 At the top of page 2, provide the patients name and ID number. 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. Inpatient services and nonparticipating providers always require prior authorization. Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 This may result in a delay of our determination response. Deutsch | This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. Please verify benefit coverage prior to rendering services. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Complete all member information fields on this form: Complete either the denial or the termination information section. Expand All In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. 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. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). 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. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content | We also want to ensure you receive the right technology that addresses your particular clinical issue. View tools for submitting prior authorizationsfor Medicare Advantage members. . Future updates regarding COVID-19 will appear in the monthly Provider News publication. Sep 1, 2021 Type at least three letters and well start finding suggestions for you. Some procedures may also receive instant approval. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Access eligibility and benefits information on the Availity Web Portal or 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. 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. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. View requirements for group and Individual members on our commercial products. Federal Employee Program. In Indiana: Anthem Insurance Companies, Inc. With prior authorization, Blue Cross of Idaho is able to: Prior authorization is just one of the ways we're working to save our members money and address rising healthcare costs. With convenience in mind, Care Centers are at the heart of the patient health journey. federal and Washington state civil rights laws. There is a list of these services in your member contract. Our resources vary by state. Use Availity to submit prior authorizations and check codes. Availity is solely responsible for its products and services. Use of the Anthem websites constitutes your agreement with our Terms of Use. AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in New Hampshire. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. FEP Basic Option/Standard OptionFEP Blue Focus. 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. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. 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. Use these lists to identify the member services that require prior authorization. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. In Kentucky: Anthem Health Plans of Kentucky, Inc. State & Federal / Medicare. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Independent licensees of the Blue Cross and Blue Shield Association. 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. website. You understand and agree that by making any Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . Please update your browser if the service fails to run our website. Blueprint Portal is a members-only website that will help you understand and manage your health plan so youre able to find quality, patient-focused healthcare at the best possible price. Other Blue Plans pre-authorization requirements may differ from ours. | * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. It looks like you're in . In Connecticut: Anthem Health Plans, Inc. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. You can access the Precertification Lookup Tool through the Availity Portal. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. 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. You can also visit bcbs.com to find resources for other states. Our electronic prior authorization (ePA) process is the preferred method for . By filling out the form completely and with as much information as possible, you can be sure we have the information to process your request timely. website and are no longer accessing or using any ABCBS Data. If you have any questions regarding our Utilization Management or Prior Authorization process, please call Customer Service at the number on the back of your identification card and they can answer any general inquiries you may have. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. Type at least three letters and we will start finding suggestions for you. You can also visit, Standard Local Prior Authorization Code List, Standard Prior Authorization Requirements, SHBP Precertification Procedure Codes Sheet, SHBP Co-pay/Co-insurance Waiver Medication List. Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. In Connecticut: Anthem Health Plans, Inc. The resources for our providers may differ between states. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. The CarelonRx member services telephone number is 833-279-0458. It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. A new prior 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. 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. In Connecticut: Anthem Health Plans, Inc. Tagalog | We want you to receive the best care at the right time and place. In some cases, we require more information and will request additional records so we can make a fully informed decision. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. More prior authorization resources Sign in to Availity Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. Prior approval for requested services - Arkansas Blue Cross and Blue Shield Prior approval for requested services The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We look forward to working with you to provide quality service for our members. Easily obtain pre-authorization and eligibility information with our tools. Contact CVS Caremark by phone at 844-345-3241 or visit their website. Sign in to the appropriate website to complete your request. . Espaol | 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. Prior authorization is required for surgical services only. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. You are invited: Advancing Mental Health Equity for Youth & Young Adults. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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, Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. To learn more read Microsoft's help article. Get Started Italiano | Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. Learn more about electronic authorization. In Kentucky: Anthem Health Plans of Kentucky, Inc. o Massachusetts Collaborative Prior Authorization Form or o Blue Cross Blue Shield of Massachusetts Pre-certification Request Form Click on the title for complete list of drugs that require prior authorization: Medical Benefit Prior Authorization Medication List, #034 Medical Utilization Management and Pharmacy Prior Authorization, #033 March 2023 Anthem Provider News - New Hampshire, February 2023 Provider Newsletter - New Hampshire, Telephonic-only care allowance extended through April 11, 2023 - New Hampshire, January 2023 Provider Newsletter - New Hampshire, Reimbursement for services by clinical behavioral health providers seeking licensure, Time to prepare for HEDIS medical record review, New policy for EMR clinical data sharing and ADT notifications, Reimbursement policy update: Modifiers 25 and 57 - Professional, Specialty pharmacy updates for March 2023, Clinical Criteria updates for specialty pharmacy. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. All rights reserved. If you choose to access other websites from this website, you agree, as a condition of choosing any such Prior to surgical treatment of gender dysphoria in FEP members, you must submit a treatment plan, including all surgeries planned, and the estimated date each will be performed. The best way to ensure you're submitting everything needed for a prior authorization is to use the prior authorization/precertification form at anthem.com/medicareprovider > Providers > Provider Resources > Forms and Guides. nor state or imply that you should access such website or any services, products or information which Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan.
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