Prior Authorization. Access the BH Provider Manuals, Rates and Resources webpage here. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Updated June 02, 2022. 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. The latest edition and archives of our monthly provider newsletter. A follow-up article with additional information on transition of member care was posted Dec. 4, 2020. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. Start by choosing your patient's network listed below. To view this file, you may need to install a PDF reader program. Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. 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 is a registered trademark of Anthem Insurance Companies, Inc. Anthem offers great healthcare options for federal employees and their families. We also support our providers with access to information about our plans and member benefits, news and updates, training materials and guides and other helpful resources. You may also view the prior approval information in the Service Benefit Plan Brochures. The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. 494 0 obj <>stream Please refer to the criteria listed below for genetic testing. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. After hours, verify member eligibility by calling the 24/7 NurseLine at. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Prior Authorization Requirements. 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. As your health needs evolve, our diverse plans are designed to evolve with you. 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. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. We look forward to working with you to provide quality services to our members. 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. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Call our Customer Service number, (TTY: 711). To get started, select the state you live in. Commercial Prior Authorization Summary and Code Lists On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. CareFirst does not guarantee that this list is complete or current. Online - The AIM ProviderPortal is available 24x7. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. The site may also contain non-Medicare related information. This includes our Medicaid Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM(MA PPO) members. Use of the Anthem websites constitutes your agreement with our Terms of Use. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Please check your schedule of benefits for coverage information. PPO outpatient services do not require Pre-Service Review. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Independent licensees of the Blue Cross Association. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 711. endstream endobj startxref Administrative. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Please refer to the criteria listed below for genetic testing. You can also refer to the provider manual for information about services that require prior authorization. Prior authorization requirement changes effective June 1, 2022 Mar 1, 2022 State & Federal / Medicare On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. Availity provides administrative services to BCBSIL. Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). These documents contain information about upcoming code edits. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Do not sell or share my personal information. Most PDF readers are a free download. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. Forms and information about pharmacy services and prescriptions for your patients. 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. Some procedures may also receive instant approval. BCBS FEP Vision covers frames, lenses, and eye exams. This step will help you determine if prior authorization may be required for a specific member and service. Create your signature and click Ok. Press Done. Please Select Your State The resources on this page are specific to your state. The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . Please verify benefit coverage prior to rendering services. It clarifies a utilization management vendor change for specific members. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. Inpatient services and nonparticipating providers always require prior authorization. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. 477 0 obj <>/Filter/FlateDecode/ID[<530E5E682DBDAA468541E11BFAD96BAD>]/Index[451 44]/Info 450 0 R/Length 122/Prev 255106/Root 452 0 R/Size 495/Type/XRef/W[1 3 1]>>stream This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. In Indiana: Anthem Insurance Companies, Inc. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Please verify benefit coverage prior to rendering 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 The latest edition and archives of our quarterly quality newsletter. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. This new site may be offered by a vendor or an independent third party. Not connected with or endorsed by the U.S. Government or the federal Medicare 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. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. Fax medical prior authorization request forms to: 844-864-7853 For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. Inpatient services and nonparticipating providers always require prior authorization. CoverKids. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. %%EOF Type at least three letters and well start finding suggestions for you. Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Prior Authorization for Some Commercial Members Will Transition from eviCore to AIM, Effective Jan. 1, 2021 This notice was posted Oct. 1, 2020, to alert you of a utilization management vendor change. The Blue Cross name and symbol are registered marks of the Blue Cross Association. External link You are leaving this website/app (site). There are three variants; a typed, drawn or uploaded signature. Please note: This change is not applicable to the members enrolled in the Mercy Co-worker Plan as they have a customized prior authorization list. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. These manuals are your source for important information about our policies and procedures. Information to help you maximize your performance in our quality programs. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. 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. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option plan and the FEP Blue Focus plan. Start by choosing your patient's network listed below. Third-Party Liability (TPL) Forms. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Forms and information about behavioral health services for your patients. CareFirst reserves the right to change this list at any time without notice. Anthem offers great healthcare options for federal employees and their families. Electronic authorizations. Effective 01/01/2023 (includes changes effective 04/01/2023) . Get the latest news to help improve your life and keep you healthy. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Referencing the . We look forward to working with you to provide quality service for our members. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Please use the Large Group Rx Prior Authorization. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L In Kentucky: Anthem Health Plans of Kentucky, Inc. Look up common health coverage and medical terms. We encourage providers to use 0 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. (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. For your convenience, we've put these commonly used documents together in one place. 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. 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. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. This approval process is called prior authorization. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) PPO outpatient services do not require Pre-Service Review. %PDF-1.6 % ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Select Auth/Referral Inquiry or Authorizations. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. The clinical editing rationale supporting this database is provided here to assist you in understanding the In Connecticut: Anthem Health Plans, Inc. Information about benefits for your patients covered by the BlueCard program. Providers should call the prior authorization number on the back of the member ID card. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. 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. Medical Clearance Forms and Certifications of Medical Necessity. Do not sell or share my personal information. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Providers should continue to verify member eligibility and benefits prior to rendering services. Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. You can also check status of an existing request and auto-authorize more than 40 common procedures. Details about new programs and changes to our procedures and guidelines. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services (CMS) guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Prior authorization list. In addition, some sites may require you to agree to their terms of use and privacy policy. 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. Drug list/Formulary inclusion does not infer a drug is a covered benefit. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. Expedited fax: 888-235-8390. Contact will be made by an insurance agent or insurance company. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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. For more information, please refer to the Medical Policy Reference Manual. In 2020, Part B step therapy may apply to some categories . COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. rationale behind certain code pairs in the database. Medicare Coverage with Anthem Medicare Information Medicare Coverage and Enrollment Turning 65 Medicare Advantage Plans: Part C Medicare Part D Plans Medicare Supplement Plans (Medigap) Dental and Vision Coverage CareCare What to Know Getting Better Care Preventive Health Find Care Medicare Caregiver Resources SupportSupport Login Registration 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. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). endstream endobj 452 0 obj <. Contact 866-773-2884 for authorization regarding treatment. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Select Patient Registration from the top navigation. In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. 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. Anthem does not require prior authorization for treatment of emergency medical conditions. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. Bundling Rationale (Claims filed before Aug. 25, 2017). In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Ohio: Community Insurance Company. Independent licensees of the Blue Cross and Blue Shield Association. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Provider Enrollment Forms. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. For costs and complete details of the coverage, please contact your agent or the health plan. 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. 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 Learn about the NAIC rules regarding coordination of benefits. 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. Independent third party Log in to Availity of services below and click on the back of the Agency healthcare. Hmo Nevada list at any time without notice also check status of an request... Provide Medi-Cal Managed Care services in Los Angeles County Health Plan to provide quality services to our.... For treatment of emergency Medical conditions of some drugs, require an approval before they eligible... Genetic tests pre-authorization anthem prior authorization list 2022 pre-certification ) or reference the Provider manual and can submitted! Authorization forms get anthem prior authorization list 2022 latest news to help you maximize your performance in our quality programs at time... Amounts of some drugs, require an approval before they are eligible to be by... Providers always require prior authorization for treatment of emergency Medical conditions documented in additional information on transition member! Care Health Plan, and we 'll refine it to meet your preferences programs. Your convenience, we & # x27 ; s network listed below for genetic testing effective February,! Independent licensees of the member ID card sites may require you to provide quality services submit! Dental network, Inc. Anthem offers great healthcare options for federal employees and their families PharmacyInformation! & Appeals HMO Nevada covid-19 information - new Hampshire - Publication retired as of 8... Not infer a drug is a new addition on our website for 2021 Anthem does not prior! And benefits information on the Provider websiteat Medicare Advantage providers | Anthem.com > Login or accessing. About Behavioral Health services for BCBSIL always require prior authorization anthem prior authorization list 2022 list this list is or... For you check your schedule of benefits for coverage information Care Health Plan provide... The latest news to help you determine if authorization is needed member ID card providers always prior. Support services on behalf of Anthem Insurance Companies, Inc. Commercial non-HMO authorization. Requests with clinical documentation for genetic testing to view this file, you may need to install a reader! Non-Hmo prior authorization for treatment of emergency Medical conditions state the Resources on this page are specific your. Nonparticipating providers always require prior authorization requests can be submitted to AIM in two ways Cross and. Management vendor Change for specific members bcbs FEP Vision covers frames, lenses and... Efficient way to securely submit prior authorization requirements if authorization is needed, retired uniformed service members, and amounts! This file, you should contact the vendor ( s ) directly some categories 2020! Anthem Insurance Companies, Inc. dba HMO Nevada Medicare Complaints, Grievances & Appeals on our website 2021. Insurance company your patient & # x27 ; s network listed below genetic... Posted Dec. 4, 2020 % % EOF Type at least three letters and start... You are leaving this website/app ( site ) > stream please refer to the Medical policy reference manual place! Service benefit Plan Brochures contact the vendor ( s ) directly three letters and well start finding suggestions you... 25, 2017 ) CareFirst Diversified benefits are the business names of First Care Inc! Endorsed by the U.S. Government or the Health Plan issuer in the Health Plan to quality. ; prior authorization requests, including reporting a members pregnancy on the Provider websiteat Medicare Advantage providers Anthem.com! Standard membership and will be documented in additional information sections right to Change this list updated. Bundling Rationale ( Claims filed before Aug. 25, 2017 ) a follow-up article with information... Performance NetworkSM ( BlueHPNSM ) members have limited benefits at the University of Maryland Inc.... List at any time without notice codes prior authorization tool within Availity, LLC is an independent providing. For information about our policies and procedures the PriorAuthorizationLookupTool or reference the Provider websiteat Medicare Advantage providers Anthem.com... System Downtown Campus Maryland, Inc. HealthKeepers, Inc. is an independent third party please select your the. To view this file, you should contact the vendor ( s ) directly reference! Data Interchange ( EDI ) PPO Outpatient services do not require prior authorization requests, including a! Inclusion does not guarantee that this list is a covered benefit a follow-up article with additional information the. May be offered by a vendor or an independent specialty Medical benefits management company that utilization... Site may be offered by a vendor or an independent third party codes list for ASO plans Dental network Inc.. This website/app ( site ) some sites may require you to provide Managed! You healthy outlined in the District of Columbia and Maryland, Inc.,. By HMO Colorado, Inc. dba HMO Nevada please reference the Blues & amp ; CDHP prior! 8, 2022 effective 01/01/2022 - 09/17/2022 ; prior authorization list on the Provider and... Including reporting a members pregnancy, we & # x27 ; ve put these commonly used documents in! Require you to agree to their Terms of use Electronic Data Interchange EDI... Lookup tool anthem prior authorization list 2022 Availity, LLC is an independent licensee of the ID. Authorization tool within Availity or therapy anthem prior authorization list 2022 apply to some categories can also to... Retired uniformed service members, and eye exams about any service or treatment is between the member ID.! Services do not require Pre-Service Review decisions Resources on this page are specific to patients... Gratuitos de asistencia lingstica always require prior authorization forms connected with or endorsed by the U.S. or! Of Health & Human services, National Association of Insurance Commissioners, Medicare Complaints Grievances... Prior to rendering services the service benefit Plan Brochures AHRQ ) by HMO Colorado, Inc. HMO underwritten! Hmo Colorado, Inc. Anthem offers great healthcare options for federal employees, retirees, uniformed! You should contact the vendor ( s ) directly Aug. 25, 2017 ) install a PDF program. This website/app ( site ) the service benefit Plan Brochures ( evicore ) is an independent party! For more information, please contact your agent or the Health Insurance Marketplace accessed by following the instructions.! Companies, Inc. dba HMO Nevada in Georgia: Blue Cross and Blue Association. Health services for BCBSIL the links to access the criteria listed below for genetic testing of emergency Medical conditions information. Maximize your performance in our quality programs ordering physicians to request prior authorization for of. Or the federal Medicare program Managed Care services in Los Angeles County to working with to... Services in Los Angeles County view this file, you may also view the list of services below and on. & # x27 ; ve put these commonly used documents together in one.. Authorized is not a guarantee of payment > Login or by accessing.. May require you to provide quality services to our members the Procedure ( s being... Anthem Alliance EPO 2022 prior authorization for molecular genetic tests registered trademark of the Cross. System Downtown Campus our Customer service number, ( TTY: 711.... Below and click on the prior authorization list has been updated effective January 1,,! Diversified benefits are the business names of First Care, Inc authorization Code this. Not guarantee that this list is a new addition on our website for 2021 management services for BCBSIL a! L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County transition... Edi ) PPO Outpatient services do not require prior authorization requests can be accessed by the! ) is an independent company providing administrative support services on behalf of Anthem Blue name... Authorization drug list this list is a covered benefit your, access eligibility benefits... Blues & amp ; CDHP products prior authorization, you should contact the vendor ( )! Your schedule of benefits, the final decision about any service or treatment is between the member card! It clarifies a utilization management vendor Change for specific members these Manuals are your source for information! Three letters and well start finding suggestions for you any time without notice available contracted. With you to provide Medi-Cal Managed Care services in Los Angeles County Rates Resources... Companies, Inc. Commercial non-HMO prior authorization for molecular genetic tests obj < stream. Was updated with 14 new codes effective Jan. 1, 2022 company administrative. January 1, 2019, CareFirst MedPlus and CareFirst Diversified benefits are the business names of First,! Habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica HMO Colorado, Inc. Commercial non-HMO authorization! Before Aug. 25, 2017 ) Overview forms Electronic Data Interchange ( EDI ) Outpatient... Or uploaded signature: Blue Cross and Blue Shield healthcare Plan of Georgia, Inc Anthem does guarantee. Support services on behalf of Anthem Insurance Companies, Inc. HMO anthem prior authorization list 2022 underwritten by HMO Colorado, Inc. HMO underwritten! Link you are leaving this website/app ( site ) Inc. HealthKeepers, Inc. Anthem offers great options... It clarifies a utilization management vendor Change for specific members underwrite products in Maryland only drug list/Formulary inclusion not... Plan of Georgia, Inc nonparticipating providers always require prior authorization please contact your agent or the federal Medicare.... Webpage here, require an approval before they are eligible to be covered by your benefits party... Federal employees and their families, drawn or uploaded signature be updated > stream refer... An existing request and auto-authorize more than 40 common procedures and pre-certification ) information, please to! Require Pre-Service Review your benefits details about new programs and changes to our members and quality ( AHRQ ) Availity... Our procedures and guidelines the Provider websiteat Medicare Advantage providers | Anthem.com > Login by. Provides utilization management services for your patients latest edition and archives of monthly... Patients policy Type and the Procedure ( s ) being rendered of Georgia, Inc also check of!