anthem blue cross prior authorization list

The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. View the FEP-specific code list and forms. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. ), 0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed), 0466T Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure. March 2023 Anthem Provider News - Georgia, February 2023 Anthem Provider News - Georgia, New ID cards for Anthem Blue Cross and Blue Shield members - Georgia, Telephonic-only care allowance extended through April 11, 2023 - Georgia, January 2023 Anthem Provider News - Georgia, prior authorization/precertification form, September 2021 Anthem Provider News - Georgia. We currently don't offer resources in your area, but you can select an option below to see information for that state. Inpatient services and nonparticipating providers always require prior authorization. In some cases, we require more information and will request additional records so we can make a fully informed decision. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. Your plan has a list of services that require prior authorization. You are invited: Advancing Mental Health Equity for Youth & Young Adults. View pre-authorization requirements for UMP members. Ting Vit | 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Your browser is not supported. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content Step 9 At the top of page 2, provide the patients name and ID number. Kreyl Ayisyen | Portugus | Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Sign in to the appropriate website to complete your request. Find care, claims & more with our new app. 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. Log into the Members portal to view the status of your prior authorization under the Claims &Eligibility menu. 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, Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. An Independent Licensee of the Blue Cross and Blue Shield Association, Summary of Benefits & Coverage Information, Sleep Testing and Therapy & Advanced Imaging, Confirm your specific treatment plan and medical necessity given your diagnosis, Determine if services are eligible for coverage, Assure your claims are processed accurately and timely, Save you from unnecessary medical expenses. In Indiana: Anthem Insurance Companies, Inc. We look forward to working with you to provide quality services to our members. 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. 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. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. Visit Anthem.com to learn more about how we coordinate our medical and pharmacy benefits, review our drug lists, submit prior authorization requests, and more. of all such websites. 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. You understand and agree that by making any Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. | This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. This may result in a delay of our determination response. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. 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. Important: Blueprint Portal will not load if you are using Internet Explorer. If you choose to access other websites from this website, you agree, as a condition of choosing any such The Blue Cross name and symbol are registered marks of the Blue Cross Association. or operation of any other website to which you may link from this website. The resources for our providers may differ between states. You can access the Precertification Lookup Tool through the Availity Portal. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Use Availity to submit prior authorizations and check codes. There is a list of these services in your member contract. Other Blue Plans pre-authorization requirements may differ from ours. benefit certificate to determine which services need prior approval. Please refer to the criteria listed below for genetic testing. 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. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. Online - The AIM ProviderPortal is available 24x7. 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. 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. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Find a Care Center. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . Some procedures may also receive instant approval. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. | In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Medical and Behavioral Health Procedure Codes Requiring Prior Authorization: Providers please note that as of the 2/1/2022 Prior Authorization release, we are moving to one document that includes authorization requirements for Medical, Durable Medical Equipment, eviCore, and Behavioral Health rather than individual documents for each specialty. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. In Maine: Anthem Health Plans of Maine, Inc. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In Ohio: Community Insurance Company. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Maine: Anthem Health Plans of Maine, Inc. You can also visit bcbs.com to find resources for other states. ABCBS makes no warranties or representations of any kind, express or implied, nor Type at least three letters and we will start finding suggestions for you. Oromoo | Step 1 At the top of the form, supply the plan/medical group name, plan/medical group phone number, and plan/medical group fax number. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation Sep 1, 2021 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. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. Complete all member information fields on this form: Complete either the denial or the termination information section. 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. website and are no longer accessing or using any ABCBS Data. View tools for submitting prior authorizationsfor Medicare Advantage members. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. We currently don't offer resources in your area, but you can select an option below to see information for that state. Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. | 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. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers.

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