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. 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. To get started, select the state you live in. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Information about benefits for your patients covered by the BlueCard program. To learn more about required Colorado timelines for decisions regarding PA requests, please click, The Colorado Prescription Drug Prior Authorization Request form, The New Hampshire Prescription Drug Uniform Prior Authorization Request Form. CareFirst Medicare Advantage requires notification/prior authorization of certain services. Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. 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. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. You can also check status of an existing request and auto-authorize more than 40 common procedures. 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. Effective 01/01/2023 (includes changes effective 04/01/2023) . This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Please refer to the criteria listed below for genetic testing. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. Create your signature and click Ok. Press Done. Prior Authorization. Start by choosing your patient's network listed below. BCBS FEP Vision covers frames, lenses, and eye exams. 494 0 obj <>stream You can also refer to the provider manual for information about services that require prior authorization. One option is Adobe Reader which has a built-in reader. To view this file, you may need to install a PDF reader program. You'll also find news and updates for all lines of business. This list contains notification/prior authorization requirements for inpatient and outpatient services. 844-912-0938 Email: OhioMedicaidProvider@anthem.com Prior authorization resources and contact information Services Requiring Prior Authorization Inpatient prior authorization fax numbers Physical health: 877-643-0671 Behavioral health: 866-577-2184 Medicaid prior authorization: 800-964-3627 Outpatient prior authorization fax numbers HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. Or Anthem offers great healthcare options for federal employees and their families. 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. These manuals are your source for important information about our policies and procedures. Musculoskeletal (eviCore): 800-540-2406. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Commercial Prior Authorization Summary and Code Lists With three rich options to choose from, weve got you covered. This new site may be offered by a vendor or an independent third party. 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. For your convenience, we've put these commonly used documents together in one place. The latest edition and archives of our quarterly quality newsletter. 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. 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., 2022. Inpatient services and nonparticipating providers always require prior authorization. External link You are leaving this website/app (site). Code Bundling Rationale 2017 Q3 CPT Codes, Code Bundling Rationale 2017 Q2CPT Codes, Code Bundling Rationale 2017 Q1CPT Codes, Code Bundling Rationale 2016 Q4CPT Codes, Code Bundling Rationale 2016 Q3CPT Codes, Code Bundling Rationale 2016 Q2CPT Codes, Code Bundling Rationale 2016 Q1CPT Codes, Code Bundling Rationale 2015 Q4CPT Codes, Code Bundling Rationale 2015 Q3CPT Codes, Code Bundling Rationale 2015 Q2CPT Codes, Code Bundling Rationale 2015 Q1CPT Codes, Code Bundling Rationale 2014 Q4CPT Codes, Code Bundling Rationale 2014 Q3CPT Codes, Code Bundling Rationale 2014 Q2CPT Codes, Code Bundling Rationale 2014 Q1CPT Codes, Code Bundling Rationale 2013 Q4CPT Codes, Code Bundling Rationale 2013 Q3CPT Codes, Code Bundling Rationale 2013 Q2CPT Codes, Code Bundling Rationale 2013 Q1CPT Codes, Code Bundling Rationale 2012 Q4CPT Codes, Code Bundling Rationale 2012 Q3CPT Codes, Code Bundling Rationale 2012 Q2CPT Codes, Code Bundling Rationale 2012 Q1CPT Codes, Code Bundling Rationale 2011 Q4CPT Codes, Code Bundling Rationale 2011 Q3CPT Codes, Code Bundling Rationale 2011 Q2CPT Codes, Code Bundling Rationale 2011 Q1CPT Codes, Code Bundling Rationale 2010 Q4CPT Codes, Code Bundling Rationale 2010 Q3CPT Codes, Code Bundling Rationale 2010 Q2CPT Codes, Code Bundling Rationale 2010 Q1CPT Codes, 1998-document.write(new Date().getFullYear()); BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Referencing the . In Maine: Anthem Health Plans of Maine, Inc. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. In Ohio: Community Insurance Company. Prior Authorization Requirements. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Medical Injectable Drugs: 833-581-1861. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Do not sell or share my personal information. 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. For your convenience, we've put these commonly used documents together in one place. AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. Long-Term Care (LTC) Forms. Provider Enrollment Forms. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. Bundling Rationale (Claims filed before Aug. 25, 2017). The "Prior authorization list" is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. State & Federal / Medicare. 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. Inpatient services and nonparticipating providers always require prior authorization. Any drugs, services, treatment, or supplies that the CareFirst medical staff determines, with appropriate consultation, to be experimental, investigational or unproven are not covered services. Anthem offers great healthcare options for federal employees and their families. The following summaries and related prior authorization lists were posted on the Support Materials (Government Programs) page as of Jan. 1, 2021: Important Reminder: Check Eligibility and Benefits First CareFirst reserves the right to change this list at any time without notice. Inpatient Clinical: 800-416-9195. In 2020, Part B step therapy may apply to some categories . Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. 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