anthem prior authorization list 2022

%%EOF To get started, select the state you live in. Please Select Your State The resources on this page are specific to your state. Call our Customer Service number, (TTY: 711). Commercial. This list contains notification/prior authorization requirements for inpatient and outpatient services. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. You can also refer to the provider manual for information about services that require prior authorization. For your convenience, we've put these commonly used documents together in one place. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. %PDF-1.6 % In Ohio: Community Insurance Company. In the event of an emergency, members may access emergency services 24/7. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. 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 Inpatient services and nonparticipating providers always require prior authorization. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Providers should continue to verify member eligibility and benefits prior to rendering services. Forms and information to help you request prior authorization or file an appeal. In addition, some sites may require you to agree to their terms of use and privacy policy. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Learn about the NAIC rules regarding coordination of benefits. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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). 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. Commercial Prior Authorization Summary and Code Lists Its important to remember that benefit plans differ in their benefits, and details such as prior authorization requirements are subject to change. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 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. In Kentucky: Anthem Health Plans of Kentucky, Inc. Contact will be made by an insurance agent or insurance company. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Expedited fax: 888-235-8390. Independent licensees of the Blue Cross and Blue Shield Association. Inpatient Clinical: 800-416-9195. Contact 866-773-2884 for authorization regarding treatment. Bundling Rationale (Claims filed before Aug. 25, 2017). You may also view the prior approval information in the Service Benefit Plan Brochures. Online - The AIM ProviderPortal is available 24x7. Type at least three letters and well start finding suggestions for you. Please verify benefit coverage prior to rendering services. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. Independent licensees of the Blue Cross Association. Here you'll find information on the available plans and their benefits. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. You'll also find news and updates for all lines of business. Please refer to the criteria listed below for genetic testing. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Please check your schedule of benefits for coverage information. Independent licensees of the Blue Cross Association. 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. 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. cost of services to the member if denied by Anthem for lack of medical necessity: (1) Procedures, equipment, and/or specialty infusio n drugs which have medically necessary criteria determined by Corporate Medical Policy or Adopted Clinical Guidelines. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. 451 0 obj <> endobj 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. 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. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. Do not sell or share my personal information. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. 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. It clarifies a utilization management vendor change for specific members. To view this file, you may need to install a PDF reader program. 711. Do not sell or share my personal information. 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. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. BCBS FEP Vision covers frames, lenses, and eye exams. In Indiana: Anthem Insurance Companies, Inc. In Connecticut: Anthem Health Plans, Inc. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 494 0 obj <>stream Please verify benefit coverage prior to rendering services. 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. Nov 1, 2021 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. 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