View the FEP-specific code list and forms. More prior authorization resources Sign in to Availity InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. We look forward to working with you to provide quality services to our members. With convenience in mind, Care Centers are at the heart of the patient health journey. 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. In Ohio: Community Insurance Company. Our resources vary by state. Complete all member information fields on this form: Complete either the denial or the termination information section. You can access the Precertification Lookup Tool through the Availity Portal. You can also visit bcbs.com to find resources for other states. Oct 1, 2020 We currently don't offer resources in your area, but you can select an option below to see information for that state. Easily obtain pre-authorization and eligibility information with our tools. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. If we deny your request for coverage or you have questions regarding your prior authorization, please call Blue Cross of Idahos Customer Service. To stay covered, Medicaid members will need to take action. Find care, claims & more with our new app. 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. 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Use Availity to submit prior authorizations and check codes. 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 helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. 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. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. We currently don't offer resources in your area, but you can select an option below to see information for that state. The Blue Cross name and symbol are registered marks of the Blue Cross 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. State & Federal / Medicare. Carelon Medical Benefits Management, Inc. You are invited: Advancing Mental Health Equity for Youth & Young Adults, Reminder: Updated Carelon Medical Benefits Management, Inc. Musculoskeletal Program effective April 1, 2023 - Site of care reviews, Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update, Provider directory - annual audit for NCQA Accreditation, Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures, March is National Colorectal Cancer Awareness Month, Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews, Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023, Pharmacy information available on our provider website, Controlling High Blood Pressure and Submitting Compliant Readings, Shared savings and transition care management after inpatient discharges. 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. Contact 866-773-2884 for authorization regarding treatment. Independent licensees of the Blue Cross Association. In some cases, we require more information and will request additional records so we can make a fully informed decision. 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 . The resources for our providers may differ between states. 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. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. nor state or imply that you should access such website or any services, products or information which Let us know! An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. FEP utilizes Magellan Rx Management for medical, Providers requesting prior approval for an ASE/PSE member should use the appropriate form on the, Providers who are requesting a prior approval for Walmart or other BlueAdvantage members should use the appropriate form from the, Providers who are requesting a prior approval for BlueMedicare or Health Advantage Medicare Advantage members should use the appropriate form from, Providers requesting prior approval for Part B drugs for BlueMedicare or Health Advantage Medicare should use the, Name and telephone number of contact person, Requesting / Performing Providers NPI or Provider ID, Copy of members insurance card (front/back), CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable, Please use the most descriptive procedure and diagnosis codes, Medical records to support requested services. Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. others in any way for your decision to link to such other websites. Information about COVID-19 and your insurance coverage. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation | 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 . Independent licensees of the Blue Cross and Blue Shield Association. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Choose your location to get started. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Typically, we complete this review within two business days, and notify you and your provider of our decision. Italiano | 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. | 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. In Indiana: Anthem Insurance Companies, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. No, the need for emergency services does not require prior authorization. You further agree that ABCBS and its March 2023 Anthem Provider News - Georgia, February 2023 Anthem Provider News - Georgia, New ID cards for Anthem Blue Cross and Blue Shield members - Georgia, Telephonic-only care allowance extended through April 11, 2023 - Georgia, January 2023 Anthem Provider News - Georgia, prior authorization/precertification form, September 2021 Anthem Provider News - Georgia. | the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible In Kentucky: Anthem Health Plans of Kentucky, Inc. . 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. Looks like you're using an old browser. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. Anthem partners with health care professionals to close gaps in care and improve members overall heath. or operation of any other website to which you may link from this website. Anthem is a registered trademark of Anthem Insurance Companies, Inc. website and are no longer accessing or using any ABCBS Data. may be offered to you through such other websites or by the owner or operator of such other websites. Once you choose to link to another website, you understand and agree that you have exited this Administrative. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . If you choose to access other websites from this website, you agree, as a condition of choosing any such 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. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content 2005 - 2022 copyright of Anthem Insurance Companies, Inc. With prior authorization, Blue Cross of Idaho is able to: Prior authorization is just one of the ways we're working to save our members money and address rising healthcare costs. 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. Prior Authorization Medication management With input from community physicians, specialty societies, and our Pharmacy & Therapeutics Committee, which includes community physicians and pharmacists from across the state, we design programs to help keep prescription drug coverage affordable. In Maine: Anthem Health Plans of Maine, Inc. You understand and agree that by making any Portugus | Some procedures may also receive instant approval. Step 11 On page 2 (2), list all diagnoses and provide theICD-9/ICD-10. Inpatient services and nonparticipating providers always require prior authorization. Your plan has a list of services that require prior authorization. 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. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Stay Covered When Medicaid Renewals Begin Medicaid renewals will start again soon. This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. P | 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. Use these lists to identify the member services that require prior authorization.