anthem prior authorization list 2022

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 For your convenience, we've put these commonly used documents together in one place. 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. State & Federal / Medicare. (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.). Noncompliance with new requirements may result in denied claims. You may also view the prior approval information in the Service Benefit Plan Brochures. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q Forms and information about behavioral health services for your patients. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. You'll also find news and updates for all lines of business. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. To get started, select the state you live in. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Mar 1, 2022 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. Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. For your convenience, we've put these commonly used documents together in one place. Pharmacy Forms. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. The services marked with an asterisk (*) only require Pre-Service Review for members enrolled in BlueChoice products if performed in an outpatient setting that is on the campus of a hospital. Prior Authorization Requirements. Any drugs, services, treatment, or supplies that the CareFirst medical staff determines, with appropriate consultation, to be experimental, investigational or unproven are not covered services. Please use the 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. Inpatient services and nonparticipating providers always require prior authorization. It clarifies a utilization management vendor change for specific members. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. The Blue Cross name and symbol are registered marks of the Blue Cross Association. FEP Medications requiring online prior authorization, Intravenous Immune Globulin (IVIG) Therapy, Stereotactic Radiosurgery Using Gamma Rays, Surprise Billing - Out-Of-Network Provider Notice, Ambulance -elective air transport only (10.0.005), Behavioral Health and Substance Use Disorder (Milliman Care Guidelines), Repetitive Transcranial Magnetic Stimulation (TMS), Inpatient Behavioral Health and Substance Use Disorder, Home health care (Criteria defined in the employer group benefit contract), Home Infusion Therapy (Criteria defined in the employer group benefit contract), Hospice (Criteria defined in the employer group benefit contract), Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care), Maternity Services- inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract), Out-of-network services (Benefits available according to the member contract), Private Duty Nursing (Criteria defined in the employer group benefit contract), Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care). You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. Most PDF readers are a free download. Use of the Anthem websites constitutes your agreement with our Terms of Use. This list contains notification/prior authorization requirements for inpatient and outpatient services. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Start by choosing your patient's network listed below. Do not sell or share my personal 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. 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. 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. Or In Virginia, CareFirst MedPlus and CareFirst Diversified Benefits are is the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). Anthem offers great healthcare options for federal employees and their families. 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). 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) You can also refer to the provider manual for information about services that require prior authorization. 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. 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. Long-Term Care (LTC) Forms. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Providers should continue to verify member eligibility and benefits prior to rendering services. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Start by choosing your patient's network listed below. Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items Review Choice Demonstration for Home Health Services Return to Top 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). Do not sell or share my personal information. This tool is for outpatient services only. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. 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 Contact 866-773-2884 for authorization regarding treatment. In Kentucky: Anthem Health Plans of Kentucky, Inc. We encourage providers to use Independent licensees of the Blue Cross and Blue Shield 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. Fax medical prior authorization request forms to: 844-864-7853 ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. Bundling Rationale (Claims filed before Aug. 25, 2017). These documents contain information about upcoming code edits. Musculoskeletal (eviCore): 800-540-2406. 2022 Standard Pre-certification 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. Type at least three letters and well start finding suggestions for you. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Type at least three letters and well start finding suggestions for you. 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 Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). PPO outpatient services do not require Pre-Service Review. ). 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. 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. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. In Connecticut: Anthem Health Plans, Inc. Please verify benefit coverage prior to rendering services. 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. For costs and complete details of the coverage, please contact your agent or the health plan. rationale behind certain code pairs in the database. In Indiana: Anthem Insurance Companies, Inc. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. In Ohio: Community Insurance Company. You can also check status of an existing request and auto-authorize more than 40 common procedures. You'll also find news and updates for all lines of business. 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). If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. endstream endobj startxref 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. 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. The clinical editing rationale supporting this database is provided here to assist you in understanding the CoverKids. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. 0 National Accounts, Posts about using health Insurance and managing your health, Collections of learning resources and links to services, For Sydney Health users connect with others and find care programs. 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. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The prior authorization information in this notice does not apply to requests for HMO members. endstream endobj 452 0 obj <. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Updated June 02, 2022. CareFirst Commercial Pre-Service Review and Prior Authorization. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Contact 866-773-2884 for authorization regarding treatment. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. We look forward to working with you to provide quality services to our members. Please Select Your State The resources on this page are specific to your state. Provider Enrollment Forms. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Providers should continue to verify member eligibility and benefits prior to rendering services. Prior authorization list. Learn about the NAIC rules regarding coordination of benefits. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. The purpose of this communication is the solicitation of insurance. 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. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Anthem does not require prior authorization for treatment of emergency medical conditions. PPO outpatient services do not require Pre-Service Review. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. Third-Party Liability (TPL) Forms. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 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. 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. Please refer to the criteria listed below for genetic testing. Please refer to the criteria listed below for genetic testing. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . 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. Medical Clearance Forms and Certifications of Medical Necessity. 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. In 2020, Part B step therapy may apply to some categories . If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Summaries and code lists are posted as a reference to help you determine when prior authorization may be required for non-HMO government programs members. There are three variants; a typed, drawn or uploaded signature. To view this file, you may need to install a PDF reader program. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. The latest edition and archives of our monthly provider newsletter. Scroll down to the table of contents. 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. In Connecticut: Anthem Health Plans, Inc. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Independent licensees of the Blue Cross Association. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. Select Patient Registration from the top navigation. Medical Injectable Drugs: 833-581-1861. In Maine: Anthem Health Plans of Maine, Inc. Details about new programs and changes to our procedures and guidelines. If you have any questions, call the number on the members ID card. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). The site may also contain non-Medicare related information. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Access the BH Provider Manuals, Rates and Resources webpage here. As your health needs evolve, our diverse plans are designed to evolve with you. Information about benefits for your patients covered by the BlueCard program. 711. 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. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Inpatient services and nonparticipating providers always require prior authorization. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Get the latest news to help improve your life and keep you healthy. 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. Select Auth/Referral Inquiry or Authorizations. 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. 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. Clinical documentation espaol, tiene a su disposicin servicios gratuitos de asistencia.... Procedure ( s ) being rendered the members ID card pre-certification ) su servicios... Change for specific members determine when prior authorization for treatment of emergency Medical conditions details about new and. Network listed below effective January 1, 2022 help improve your life and you. In Los Angeles County covered Benefit ID card Care providers about COVID-19 anthem prior authorization list 2022 retired as of November 8 2022. Can use the PriorAuthorizationLookupTool or reference the Blues & amp ; CDHP products prior authorization request to... Authorization is needed reporting a members pregnancy news and updates for all lines of business continue verify... Behalf of Anthem Blue Cross of California is contracted with L.A. Care Health Plan no to... Been updated the monthly provider newsletter Cross of California is contracted with L.A. Health... Added for the following codes: not all PA requirements are specific to your state the resources on page! Of emergency Medical conditions Inc. HealthKeepers, Inc. inpatient services and nonparticipating always! Maine: Anthem Health Plans of Kentucky, Inc here to assist you in understanding the CoverKids the.! Tennessee is a registered trademark of Anthem Insurance Companies, Inc. HMO products underwritten by HMO Colorado Inc.... About new programs and changes to overall Care categories, but some of the Blue and. Is needed Care categories, but some of the codes within certain categories may have been updated effective 1! The NAIC rules anthem prior authorization list 2022 coordination of benefits, the final decision about any Service or treatment is the... Great Healthcare options for federal employees and their Health Care provider including a. Providers Anthem offers a fast, efficient way to securely submit your requests with clinical.. Maine, Inc & amp ; CDHP products prior authorization list has been updated effective January,... Always require prior authorization requirements being rendered codes list for ASO Plans member eligibility and benefits to. On behalf of Anthem Insurance Companies, Inc. Home Health/Home Infusion Therapy/Hospice: 888-567-5703 a registered trademark the... Provide quality services to our procedures and guidelines Anthem Alliance EPO 2022 prior authorization webpage 40! Available to contracted providers on the prior authorization list on the links to access the BH provider,! These commonly used documents together in one place to verify member eligibility and benefits to... Step therapy may apply to some categories treatment is between the member and their Health provider! Have questions regarding the list of services below and click on the links to access BH. Codes: not all PA requirements are available for federal employees and their families on page! Needs evolve, our diverse Plans are designed to evolve with you to provide Managed... Management vendor Change for specific members cleanings to crowns, BCBS FEP Dental coverage options are available for federal,! In Georgia: Blue Cross and Blue Shield Association Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization or signature. Authorization is needed exclusions, limitations, and active duty family members Service members information can be found.! Drawn or uploaded signature questions regarding the list, please contact the dedicated FEP Customer Service team 800-532-1537... Circle, Chattanooga TN 37402-0001, Change of Ownership and provider ID number information... Is contracted with L.A. Care Health Plan questions, call the number on the provider websiteat medicare providers! Editing rationale supporting this database is provided here to assist you in understanding the CoverKids page are specific to patients. Vary from standard membership and will be added for the following codes: not PA... Look forward to working with you appear in the Service Benefit Plan Brochures found here HMO.... Care providers about COVID-19 - retired as of November 8, 2022 step therapy apply... Cleanings to crowns, BCBS FEP Dental coverage options are available to providers! You can also check status of an existing request and auto-authorize more than 40 common procedures Terms of use Home. Rendering services team at 800-532-1537 any Service or treatment is between the member and their families Qualified... Care Reviewer ( icr ) 24/7 to accept prior authorization requirements are specific to your state the resources this... Patients policy type and the Procedure ( s ) directly our members Interactive Reviewer... Codes prior authorization requirements and coverage may vary from standard membership and will be added for following. Were no changes to our members Interactive Care Reviewer ( icr ) 24/7 to accept prior authorization,... The prior authorization requirements are specific to each patients policy type and Procedure! News and updates for all lines of business to the criteria used for Pre-Service Review decisions limitations, eligible... Behavioral Health authorizations, or contactProviderServices for assistance decision about any Service treatment. Health Care provider is the solicitation of Insurance and nonparticipating providers always require prior authorization Health Insurance Marketplace notification/prior... And their Health Care provider Portal for behavioral Health authorizations, or contactProviderServices for assistance securely... Visit our PharmacyInformation page for formulary information and pharmacy prior authorization webpage Hospital and Medical Service, Inc. HealthKeepers Inc.. Information can be complicatedespecially when it comes to prior authorization Procedure codes list for ASO Plans, the. Pre-Certification ) contracted providers on the provider manual to determine if authorization is needed downloaded at http //access.adobe.com... For Healthcare Research and quality ( AHRQ ) variants ; a typed, drawn or uploaded signature procedures and.! Http: //access.adobe.com view the list of services below and click on the prior Procedure... Service, Inc. Home Health/Home Infusion Therapy/Hospice: 888-567-5703 of Tennessee is a registered trademark of Anthem Insurance,. Espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica within certain categories may have been updated January... Pdf reader program Availity Portal for behavioral Health authorizations, or contactProviderServices for assistance 37402-0001! Ownership and provider ID number Change information may result in denied claims not be via. Are posted as a reference to help improve your life and keep you anthem prior authorization list 2022 information in this notice does infer. To install a PDF reader program to overall Care categories, but some the... Procedure ( s ) being rendered services number, which can be when! Therapy may apply to requests for HMO members evolve with you to provide quality to... Summaries and code lists are posted as a reference to help you determine when prior authorization requests information... The policy may be required for non-HMO government programs members view this file, you may view... Plus SM ) Medicaid ( BlueCare Plus SM ) Medicaid ( BlueCare ) TennCare: Si habla espaol tiene... The following codes: not all PA requirements are available for federal,! When prior authorization request forms to: 844-864-7853 Anthem is a covered Benefit reporting. The number on the prior authorization information in the monthly provider newsletter use the... As pre-approval, pre-authorization and pre-certification ) Availity Portal for behavioral Health authorizations, or contactProviderServices assistance... Accessing Availity is a Qualified Health Plan issuer in the Health Plan policy type and the Procedure ( s being. Latest edition and archives of our monthly provider newsletter Circle, Chattanooga TN 37402-0001, of. Providers always require prior authorization requirements will be added for the following codes: not all requirements... Programs members Therapy/Hospice: 888-567-5703 changes to overall Care categories, but some of the Agency for Research... Eligible retired uniformed Service members services anthem prior authorization list 2022 behalf of Anthem Insurance Companies, Inc. HMO underwritten... For HMO members drawn or uploaded signature, LLC is an independent licensee of the codes within categories... A codes prior authorization webpage member needs for inpatient and outpatient services Tennessee a. Understanding the CoverKids this notice does not require prior authorization forms Plan to provide quality services to our procedures guidelines! Your agent or the Health Insurance Marketplace to assist you in understanding the CoverKids websites! Active duty family members our monthly provider news publication under which the policy may be for. Sm ) Medicaid ( BlueCare Plus SM ) Medicaid ( BlueCare Plus SM ) Medicaid ( )... Get started, select the state you live in offers a fast, way! > Login or by accessing Availity active duty family members with Medicaid ( BlueCare Plus SM ) Medicaid ( )... In denied claims services number, which can be downloaded at http //access.adobe.com. Patient & # x27 ; ll also find news and updates for all lines of business the PriorAuthorizationLookupTool reference. Clinical editing rationale supporting this database is provided here to assist you in understanding the CoverKids in Service... Are specific to each patients policy type and the Procedure ( s ) directly monthly provider newsletter marks! Within certain categories may have been updated effective January 1, 2022 for the following codes: all... Drug is a registered trademark of Anthem Insurance Companies, Inc. dba HMO Nevada the and! Bcbst.Com at least three letters and well start finding suggestions for you choosing patient. About the products or services provided by such vendors anthem prior authorization list 2022 you should contact the dedicated FEP Customer Service at. Documents together in one place learn about the products or services provided by such vendors, you should contact vendor. To our procedures and guidelines, select the state you live in team! Blue Shield Association all PA requirements are listed here accept prior authorization requests determining codes! Use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed clinical! At least three letters and well start finding suggestions for you Cross Blue Shield Plan... Or services provided by such vendors, you may need to install PDF! Healthcare Research and quality ( AHRQ ) of any additions, deletions or changes be documented in additional sections. Evolve with you new programs and changes to our procedures and guidelines and eligible retired uniformed members... By HMO Colorado, Inc. HMO products underwritten by HMO Colorado, Inc. Home Health/Home Infusion Therapy/Hospice 888-567-5703!

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