Prior authorization lookup tool | Georgia Provider - Amerigroup 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. If youre concerned about losing coverage, we can connect you to the right options for you and your family. Quickly and easily submit out-of-network claims online. Select Auth/Referral Inquiry or Authorizations. We are also licensed to use MCG guidelines to guide utilization management decisions. Please update your browser if the service fails to run our website. Health Benefits for Federal Employees | Anthem Our resources vary by state. 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. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. In Maine: Anthem Health Plans of Maine, Inc. Pay outstanding doctor bills and track online or in-person payments. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Reason Code 16 | Remark Codes MA13 N265 N276 - JA DME If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. The purpose of this communication is the solicitation of insurance. In Kentucky: Anthem Health Plans of Kentucky, Inc. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. These guidelines do not constitute medical advice or medical care. For subsequent inpatient care, see 99231-99233. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Access eligibility and benefits information on the Availity* Portal OR. Where is the Precertification Lookup Tool located on Availity? Find out if a service needs prior authorization. Prior authorization lookup tool| HealthKeepers, Inc. The resources on this page are specific to your state. It looks like you're in . Please update your browser if the service fails to run our website. Explore programs available in your state. 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. Were committed to supporting you in providing quality care and services to the members in our network. Prior authorizations are required for: All non-par providers. Click Submit. 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. A group NPI cannot be used as ordering NPI on a Medicare claim. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. If this is your first visit, be sure to check out the. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). We offer affordable health, dental, and vision coverage to fit your budget. The resources for our providers may differ between states. Explore our resources. Providers | Tools, Resources & More | Anthem.com To stay covered, Medicaid members will need to take action. 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.) Our resources vary by state. They are not agents or employees of the Plan. Enter one or more keyword (s) for desired policy or topic. You can also type part of the code's description to search, for example type "tonsil" to find "Removal of tonsils." This tool can be used to check if a prior authorization is required for health care services covered by Blue Cross and Blue Shield of Minnesota commercial health plans, Medicare Advantage and Platinum Blue. 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. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. Your online account is a powerful tool for managing every aspect of your health insurance plan. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. If your state isn't listed, check out bcbs.com to find coverage in your area. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. We look forward to working with you to provide quality service for our members. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Our resources vary by state. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. The resources for our providers may differ between states. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Provider Reimbursement Policies | Anthem.com We update the Code List to conform to the most recent publications of CPT and HCPCS . Find drug lists, pharmacy program information, and provider resources. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Current Procedural Terminology, more commonly known as CPT, refers to a medical code set created and maintained by the American Medical Association and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. Access to the information does not require an Availity role assignment, tax ID or NPI. Please verify benefit coverage prior to rendering services. 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. In Indiana: Anthem Insurance Companies, Inc. 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. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. 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. In Connecticut: Anthem Health Plans, Inc. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Vaccination is important in fighting against infectious diseases. For Providers: Medical Policy and Pre-Cert/Pre-Auth Router - BCBSM Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Plus, you may qualify for financial help to lower your health coverage costs. You can also visit. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. You are using an out of date browser. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. Enter a CPT or HCPCS code in the space below. 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. 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. 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. Provider Communications 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). 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. Your browser is not supported. Prior-Authorization And Pre-Authorization | Anthem.com In Kentucky: Anthem Health Plans of Kentucky, Inc. Additional medical policies may be developed from time to time and some may be withdrawn from use. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. We want to help physicians, facilities and other health care professionals submit claims accurately. Select Your State Self-Service Tools Apr 1, 2022 New member? There are several factors that impact whether a service or procedure is covered under a members benefit plan. We currently don't offer resources in your area, but you can select an option below to see information for that state. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Members should discuss the information in the clinical UM guideline with their treating health care providers. 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. Your dashboard may experience future loading problems if not resolved. Future updates regarding COVID-19 will appear in the monthly Provider News publication.