Enter a Current Procedural Terminology (CPT) code in the space below to get started. We look forward to working with you to provide quality service for our members. 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., 2023. It looks like you're outside the United States. The resources for our providers may differ between states. 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. The MCG guidelines we are licensed to use include ((1) Inpatient & Surgical Care (ISC), (2) General Recovery Care (GRG), (3) Recovery Facility Care (RFC), (4) Chronic Care (CC) and (5) Behavioral Health Care Guidelines (BHG). The notices state an overpayment exists and Anthem is requesting a refund. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. 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. We offer flexible group insurance plans for any size business. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Enter one or more keyword (s) for desired policy or topic. Our resources vary by state. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. 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., 2023. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manualand support for delivering benefits to our members. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. It may not display this or other websites correctly. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Medicare Complaints, Grievances & Appeals. Find out if a service needs prior authorization. Inpatient services and non-participating providers always require prior authorization. The doctors, hospitals, and other providers which are part of the network of providers referred to in this document are independent contractors who exercise independent judgment and over whom we have no control or right of control. Choose your state below so that we can provide you with the most relevant information. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. 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. You can access the Precertification Lookup Tool through the Availity Portal. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). Review medical and pharmacy benefits for up to three years. Please Select Your State The resources on this page are specific to your state. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. If a prior authorization (PA) is required (indicates "yes" or "no") If there are PA conditions; If the service is a covered benefit (indicates "covered" or "not covered") Call Provider Services at 1-800-454-3730 (TTY 711) After hours, verify member eligibility by calling the 24/7 Nurse HelpLine at 1-800-600-4441. Choose your state below so that we can provide you with the most relevant information. Your dashboard may experience future loading problems if not resolved. To get started, select the state you live in. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. 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. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. We currently don't offer resources in your area, but you can select an option below to see information for that state. If youre concerned about losing coverage, we can connect you to the right options for you and your family. Use the Prior Authorization tool within Availity OR. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Please verify benefit coverage prior to rendering services. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. The purpose of this communication is the solicitation of insurance. No provider of outpatient services gets paid without reporting the proper CPT codes. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Start by logging onto Availity.com and selecting the Register icon at the top of the home screen or use this link to access the registration page. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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., 2023. out of your benefits, find the best healthcare, and stay healthy. 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. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. Find drug lists, pharmacy program information, and provider resources. Enter a CPT or HCPCS code in the space below. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. With Codify by AAPC cross-reference tools, you can check common code pairings. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. 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. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). In Ohio: Community Insurance Company. March 2023 Anthem Provider News - Missouri, February 2023 Anthem Provider News - Missouri, New ID cards for Anthem Blue Cross and Blue Shield members - Missouri, Telephonic-only care allowance extended through April 11, 2023 - Missouri, January 2023 Anthem Provider News - Missouri, April 2022 Anthem Provider News - Missouri, enable member benefit lookup by CPT and HCPC procedure codes, Enter up to eight procedure codes per transaction, provide additional cost share information by place of service, return Is Authorization Required? information, include additional plan-level benefit limitations. To stay covered, Medicaid members will need to take action. There is no cost for our providers to register or to use any of the digital applications. 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. Please verify benefit coverage prior to rendering services. Interested in joining our provider network? We look forward to working with you to provide quality service for our members. State & Federal / Medicaid. Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. The resources on this page are specific to your state. Access to the information does not require an Availity role assignment, tax ID or NPI. You are using an out of date browser. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. Independent licensees of the Blue Cross and Blue Shield Association. 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. Independent licensees of the Blue Cross and Blue Shield Association. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Contact will be made by an insurance agent or insurance company. Health equity means that everyone has the chance to be their healthiest. Type at least three letters and well start finding suggestions for you. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. In Maine: Anthem Health Plans of Maine, Inc. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. 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). Price a medication, find a pharmacy,order auto refills, and more. While the clinical UM guidelines developed by us are published on this web site, the licensed standard and customized MCG guidelines are proprietary to MCG and are not published on the Internet site. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. Taking time for routine mammograms is an important part of staying healthy. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Choose your location to get started. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. Access your member ID card from our website or mobile app. ET. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Choose your location to get started. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. If you are unsure or have any questions, please be sure to check member eligibility and benefit coverage before proceeding with any authorization requests or services by contacting Provider Services at 800-901-0020. Our resources vary by state. Directions. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Once youve accessed the Precertification Lookup Tool, choose a line of business from the menu selection offered, and then type the CPT/HCPCS code or a code description to determine if a prior authorization is required. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. We are also licensed to use MCG guidelines to guide utilization management decisions. Please note that services listed as requiring precertification may not be covered benefits for a member. We update the Code List to conform to the most recent publications of CPT and HCPCS . Members should contact their local customer service representative for specific coverage information. Inpatient services and non-participating providers always require prior authorization. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. New member? Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS.
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