Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. Independent licensees of the Blue Cross and Blue Shield Association. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. 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. 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. 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. Some procedures may also receive instant approval. In Maine: Anthem Health Plans of Maine, Inc. 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. 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 primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. View tools for submitting prior authorizationsfor Medicare Advantage members. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. We also want to ensure you receive the right technology that addresses your particular clinical issue. It looks like you're outside the United States. Prior authorization is not a guarantee of payment. In Connecticut: Anthem Health Plans, Inc. Deutsch | In some cases, we require more information and will request additional records so we can make a fully informed decision. Your browser is not supported. 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. View pre-authorization requirements for UMP members. We look forward to working with you to provide quality service for our members. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). 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). . 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. Type at least three letters and we will start finding suggestions for you. nor state or imply that you should access such website or any services, products or information which Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. color, national origin, age, disability, sex, gender identity, or sexual orientation. 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. 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 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. 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. 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. | 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. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). We look forward to working with you to provide quality services to our members. The resources for our providers may differ between states. Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Your dashboard may experience future loading problems if not resolved. | Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). You can also refer to the provider manual for information about services that require prior authorization. Please refer to the criteria listed below for genetic testing. Independent licensees of the Blue Cross and Blue Shield Association. 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 Kentucky: Anthem Health Plans of Kentucky, Inc. If your state isn't listed, check out bcbs.com to find coverage in your area. Choose your location to get started. Sign in to the appropriate website to complete your request. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. 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. 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. Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Complete all member information fields on this form: Complete either the denial or the termination information section. View the FEP-specific code list and forms. 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. View requirements for Basic Option, Standard Option and FEP Blue Focus. Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. To learn more read Microsoft's help article. You can also visit bcbs.com to find resources for other states. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. Updated June 02, 2022. Franais | In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Sep 1, 2021 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. 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. 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. 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. | View medication policies and pre-authorization requirements. There is a list of these services in your member contract. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. Portugus | Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual. Learn more about electronic authorization. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. ), 0480T Fractional ablative laser fenestration of burn and traumatic scars for functional improvement; each additional 100 cm2, or each additional 1% of body surface area of infants and children, or part thereof (List separately in addition to code for primary procedure. Online - The AIM ProviderPortal is available 24x7. 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. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. We want you to receive the best care at the right time and place. Step 9 At the top of page 2, provide the patients name and ID number. L3927 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (for example, static or ring type), may include soft interface material, prefabricated, L5301 Below knee, molded socket, shin, SACH foot, endoskeletal system, L5321 Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee, L5645 Addition to lower extremity, below knee (BK), flexible inner socket, external frame, L5649 Addition to lower extremity, ischial containment/narrow M-L socket, L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each, 0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed, 0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure.