anthem blue cross prior authorization list

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Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. If yes, provide the medication name, dosage, duration of therapy, and outcome. State & Federal / Medicare. link or access, that Arkansas Blue Cross and Blue Shield (ABCBS) is not and shall not be responsible or liable to you or to 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. Your dashboard may experience future loading problems if not resolved. Have you reviewed your online provider directory information lately? | The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Complete all member information fields on this form: Complete either the denial or the termination information section. Our resources vary by state. View the FEP-specific code list and forms. 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. 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. 2021 copyright of Anthem Insurance Companies, Inc. As a leader in managed healthcare services for the public sector, Anthem Blue Cross and Blue Shield Medicaid helps low-income families, children and pregnant women get the healthcare they need. There is a list of these services in your member contract. With convenience in mind, Care Centers are at the heart of the patient health journey. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. This may result in a delay of our determination response. In Connecticut: Anthem Health Plans, Inc. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, L3925 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), non-torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf. In Indiana: Anthem Insurance Companies, Inc. 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. Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Anthem is a registered trademark of Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. Updated June 02, 2022. 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. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for 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. Our electronic prior authorization (ePA) process is the preferred method for . others in any way for your decision to link to such other websites. 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. 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. Noncompliance with new requirements may result in denied claims. | Electronic authorizations. 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. Online - The AIM ProviderPortal is available 24x7. 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. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. Prior authorization suspension for Anthem Ohio in-network hospital transfers to in-network skilled nursing facilities effective December 20, 2022 to January 15, 2023: Prior authorization suspension - In-network hospital transfers to In-network SNFs . 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. Posted Jan. 11, 2021. 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. Federal Employee Program. To request authorizations: From the Availity home page, select Patient Registration from the top navigation. In Indiana: Anthem Insurance Companies, Inc. of all such websites. Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). ), 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation, 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach, 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach, 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach, 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy), 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis, 33419 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure), 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed, 33979 Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle, 33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only, 36514 Therapeutic Apheresis; Plasma Pheresis, 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection, 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed, A4224 Supplies for maintenance of insulin infusion catheter, per week, A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each, A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe, A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fah, A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each, A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries, C1722 Cardioverter-defibrillator, single chamber (implantable), L5671 Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert, L5673 Addition to lower extremity, below knee/above knee, custom fabricated, L5679 Addition to lower extremity, below knee/above knee, custom fabricated, L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature, L5981 All lower extremity prostheses, flex-walk system or equal, L5987 All lower extremity prostheses, shank foot system with vertical loading pylon, L8699 Prosthetic implant, not otherwise specified, L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code. Kreyl Ayisyen | If you have any questions regarding our Utilization Management or Prior Authorization process, please call Customer Service at the number on the back of your identification card and they can answer any general inquiries you may have. Learn more about electronic authorization. ), 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. | 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. Select Auth/Referral Inquiry or Authorizations. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. 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. Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. In Indiana: Anthem Insurance Companies, Inc. You are invited: Advancing Mental Health Equity for Youth & Young Adults. All rights reserved. under any circumstances for the activities, omissions or conduct of any owner or operator of any other Type at least three letters and we will start finding suggestions for you. 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. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content Please update your browser if the service fails to run our website. You understand and agree that by making any Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. color, national origin, age, disability, sex, gender identity, or sexual orientation. The resources for our providers may differ between states. The site may not work properly. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Use the search tool to find the Care Center closest to you. Get Started The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. 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. 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. Therefore, its important for you to know your benefits and covered services. 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. Franais | * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Medical Policy and Prior Authorization for Blue Plans. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Availity is solely responsible for its products and services. . Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members

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