Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. In Ohio: Community Insurance Company. Anthem does not require prior authorization for treatment of emergency medical conditions. 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. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. 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. This tool is for outpatient services only. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. Denial of MH-TCM services is defined as the initial determination that a member does not meet the criteria for MH-TCM services. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Stay Covered When Medicaid Renewals Begin Medicaid renewals will start again soon. In the event of an emergency, members may access emergency services 24/7. Let us know! Some procedures may also receive instant approval. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. March 2023 Anthem Provider News - New Hampshire, February 2023 Provider Newsletter - New Hampshire, Telephonic-only care allowance extended through April 11, 2023 - New Hampshire, January 2023 Provider Newsletter - New Hampshire, Reimbursement for services by clinical behavioral health providers seeking licensure, Time to prepare for HEDIS medical record review, New policy for EMR clinical data sharing and ADT notifications, Reimbursement policy update: Modifiers 25 and 57 - Professional, Specialty pharmacy updates for March 2023, Clinical Criteria updates for specialty pharmacy. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. We also want to ensure you receive the right technology that addresses your particular clinical issue. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. 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. Noncompliance with new requirements may result in denied claims. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. 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. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. 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. Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Deutsch | Ting Vit | Provider Communications * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. If you're concerned about losing coverage, we can connect you to the right options for you and your family. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. Easily obtain pre-authorization and eligibility information with our tools. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Independent licensees of the Blue Cross Association. State & Federal / Medicare. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. The resources for our providers may differ between states. | Kreyl Ayisyen | nor state or imply that you should access such website or any services, products or information which Online - The AIM ProviderPortal is available 24x7. Select Auth/Referral Inquiry or Authorizations. View tools for submitting prior authorizationsfor Medicare Advantage members. 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. Pharmacy Information for Providers | Anthem.com - Empire Blue Out-of-area providers Prior Authorization | BCBSMN - Blue Cross MN Updated June 02, 2022. Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL 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. ), 0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed), 0466T Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure. If yes, provide the medication name, dosage, duration of therapy, and outcome. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Inpatient services and nonparticipating providers always require prior authorization. PPO outpatient services do not require Pre-Service Review. 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 Blue Shield: Health Insurance, Medicare & More | may be offered to you through such other websites or by the owner or operator of such other websites. Use the search tool to find the Care Center closest to you. Prior-Authorization And Pre-Authorization | Anthem.com Your dashboard may experience future loading problems if not resolved. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. Availity is solely responsible for its products and services. 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. View requirements for group and Individual members on our commercial products. Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). Prior authorization/precertification form notification - Anthem Independent licensees of the Blue Cross and Blue Shield Association. Oct 1, 2020 Administrative. In Maine: Anthem Health Plans of Maine, Inc. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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). With convenience in mind, Care Centers are at the heart of the patient health journey. Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. Provider Communications Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. In Kentucky: Anthem Health Plans of Kentucky, Inc. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. We look forward to working with you to provide quality services to our members. We look forward to working with you to provide quality service for our members. Contact 866-773-2884 for authorization regarding treatment. Our resources vary by state. Espaol | Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. If you choose to access other websites from this website, you agree, as a condition of choosing any such Our electronic prior authorization (ePA) process is the preferred method for . Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the members ID card. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. Please update your browser if the service fails to run our website. | 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. Prior Authorization Requirement Summaries, Code Lists and - BCBSIL Anthem is a registered trademark of Anthem Insurance Companies, Inc. View medication policies and pre-authorization requirements. This form should only be used for Arkansas Blue Cross and Blue Shield members. If your state isn't listed, check out bcbs.com to find coverage in your area. PDF Outpatient Prior Authorization Code - Blue Cross Blue Shield of Use of the Anthem websites constitutes your agreement with our Terms of Use. 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. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . Find a Care Center. Complete all member information fields on this form: Complete either the denial or the termination information section. Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. Anthem Blue Cross and Blue Shield will begin reimbursing for services provided by unlicensed clinical behavioral health providers actively seeking licensure in New Hampshire. the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible | This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. TransactRx and CoverMyMeds are separate and independent companies that provide pharmacy pre-authorization and claims submission for Regence members. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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.