We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. New member? We are also licensed to use MCG guidelines to guide utilization management decisions. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. The resources on this page are specific to your state. 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. We look forward to working with you to provide quality service for our members. 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. 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. 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Vaccination is important in fighting against infectious diseases. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Large Group All other available Medical Policy documents are published by policy/topic title. The medical policies do not constitute medical advice or medical care. The notices state an overpayment exists and Anthem is requesting a refund. Please Select Your State The resources on this page are specific to your state. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. 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. Inpatient services and nonparticipating providers always require prior authorization. Please verify benefit coverage prior to rendering services. It looks like you're outside the United States. 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. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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.) 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. Our research shows that subscribers using Codify by AAPC are 33% more productive. If your state isn't listed, check out bcbs.com to find coverage in your area. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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 update your browser if the service fails to run our website. If your state isn't listed, check out bcbs.com to find coverage in your area. We currently don't offer resources in your area, but you can select an option below to see information for that state. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. You can also visit. Out-of-state providers. 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. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Pay outstanding doctor bills and track online or in-person payments. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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. Please update your browser if the service fails to run our website. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. Or Inpatient services and non-participating providers always require prior authorization. Our resources vary by state. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. You can also visit bcbs.com to find resources for other states. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. In Kentucky: Anthem Health Plans of Kentucky, Inc. Members should discuss the information in the medical policies with their treating health care professionals. 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. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. You can also visit bcbs.com to find resources for other states. Do not sell or share my personal information. In Maine: Anthem Health Plans of Maine, Inc. 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. Please verify benefit coverage prior to rendering services. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. 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. 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. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Find answers to all your questions with an Anthem representative in real time. The tool will tell you if that service needs . Inpatient services and non-participating providers always require prior authorization. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Here you'll find information on the available plans and their benefits. In Indiana: Anthem Insurance Companies, Inc. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Find drug lists, pharmacy program information, and provider resources. Members should contact their local customer service representative for specific coverage information. 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. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Our resources vary by state. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Please verify benefit coverage prior to rendering services. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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. Find drug lists, pharmacy program information, and provider resources. A group NPI cannot be used as ordering NPI on a Medicare claim. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. Your browser is not supported. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Our resources vary by state. 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 If you arent registered to use Availity, signing up is easy and 100% secure. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. These guidelines do not constitute medical advice or medical care. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. We look forward to working with you to provide quality services to our members. 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. To get started, select the state you live in. With Codify by AAPC cross-reference tools, you can check common code pairings. Members should discuss the information in the clinical UM guideline with their treating health care providers. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Review medical and pharmacy benefits for up to three years. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. 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. Access to the information does not require an Availity role assignment, tax ID or NPI. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. There are several factors that impact whether a service or procedure is covered under a members benefit plan. Your dashboard may experience future loading problems if not resolved. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Anthem is a registered trademark of Anthem Insurance Companies, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Select Auth/Referral Inquiry or Authorizations. Available for iOS and Android devices. Enter one or more keyword (s) for desired policy or topic. You are using an out of date browser. Understand your care options ahead of time so you can save time and money. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. We currently don't offer resources in your area, but you can select an option below to see information for that state. Audit reveals crisis standards of care fell short during pandemic. Choose your location to get started. JavaScript is disabled. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started. 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 authorizations are required for: All non-par providers. If your state isn't listed, check out bcbs.com to find coverage in your area. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Administrative / Digital Tools, Learn more by attending this live webinar. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. Please verify benefit coverage prior to rendering services. Taking time for routine mammograms is an important part of staying healthy. The resources for our providers may differ between states. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. 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. Youll also strengthen your appeals with access to quarterly versions since 2011. State & Federal / Medicaid. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. The MCG guidelines we are licensed to use include ((1) Inpatient & Surgical Care (ISC), (2) General Recovery Care (GRG), (3) Recovery Facility Care (RFC), (4) Chronic Care (CC) and (5) Behavioral Health Care Guidelines (BHG). We look forward to working with you to provide quality service for our members. Medicaid renewals will start again soon. Apr 1, 2022 Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Independent licensees of the Blue Cross and Blue Shield Association. Search by keyword or procedure code for related policy information. Choose your location to get started. Provider Medical Policies | Anthem.com Find information that's tailored for you. Your dashboard may experience future loading problems if not resolved. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. Make your mental health a priority. Select a State Policies & Guidelines Medical Policies & Clinical UM Guidelines There are several factors that impact whether a service or procedure is covered under a member's benefit plan. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. Health equity means that everyone has the chance to be their healthiest. You can access the Precertification Lookup Tool through the Availity Portal. We look forward to working with you to provide quality service for our members. 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. We update the Code List to conform to the most recent publications of CPT and HCPCS .
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