There is no cost for our providers to register or to use any of the digital applications. CPT Code Lookup, CPT Codes and Search - Codify by AAPC For Providers: Medical Policy and Pre-Cert/Pre-Auth Router - BCBSM 2005 - 2023 copyright of Anthem Insurance Companies, Inc. They are not agents or employees of the Plan. It does not reflect benefits coverage, nor does it include an exhaustive listing of all non-covered services (in other words, experimental procedures, cosmetic surgery, etc.). Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. Inpatient services and nonparticipating providers always require prior authorization. Where is the Precertification Lookup Tool located on Availity? This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. 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. This tool is for outpatient services only. The resources for our providers may differ between states. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Large Group The resources on this page are specific to your state. 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. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. It looks like you're in . 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. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. 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. After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-224-0336. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Explore our resources. In Ohio: Community Insurance Company. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. 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. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. Medicaid renewals will start again soon. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. We currently don't offer resources in your area, but you can select an option below to see information for that state. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Lets make healthy happen. Precertification Lookup Tool | Healthy Blue 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. The medical policies do not constitute medical advice or medical care. Please note: This tool is for outpatient services only. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Choose your state below so that we can provide you with the most relevant information. Access eligibility and benefits information on the Availity* Portal OR. Choose your location to get started. You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed. Self-Service Tools 711. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. We look forward to working with you to provide quality services to our members. We currently don't offer resources in your area, but you can select an option below to see information for that state. Precertification Lookup Tool -- easy access to prior - Anthem 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. JavaScript is disabled. Prior Authorization Lookup Tool - Anthem Blue Cross 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. Quickly and easily submit out-of-network claims online. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. Review medical and pharmacy benefits for up to three years. You can also visit bcbs.com to find resources for other states. 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. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. Please verify benefit coverage prior to rendering services. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Please update your browser if the service fails to run our website. Please verify benefit coverage prior to rendering services. To get started, select the state you live in. We want to help physicians, facilities and other health care professionals submit claims accurately. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Youll also strengthen your appeals with access to quarterly versions since 2011. 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. Find drug lists, pharmacy program information, and provider resources. You can access the Precertification Lookup Tool through the Availity Portal. Directions. Copyright 2023. Do not sell or share my personal information. It looks like you're in . We update the Code List to conform to the most recent publications of CPT and HCPCS . Out-of-state providers. The resources for our providers may differ between states. Understand your care options ahead of time so you can save time and money. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. 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. The resources for our providers may differ between states. 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. 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. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. Prior Authorization Lookup. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Independent licensees of the Blue Cross Association. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. 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. Prior authorization lookup tool | Blue Cross MN Use of the Anthem websites constitutes your agreement with our Terms of Use. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. For medical policies for other Blue plans, use the Medical Policy & Pre-Cert/Pre-Auth Router. Your browser is not supported. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. E0731 Conductive garment for Tens G0460 Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment L3000 Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each It looks like you're in . Find drug lists, pharmacy program information, and provider resources. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Members should discuss the information in the medical policies with their treating health care professionals. Prior authorization lookup tool| HealthKeepers, Inc. - Anthem Your browser is not supported. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. They are not agents or employees of the Plan. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). You can also visit. Our resources vary by 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. Your dashboard may experience future loading problems if not resolved. New member? There are several factors that impact whether a service or procedure is covered under a members benefit plan. Click Submit. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Provider Medical Policies | Anthem.com In Connecticut: Anthem Health Plans, Inc. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. This tool is for outpatient services only. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. 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). Anthem offers great healthcare options for federal employees and their families. Our resources vary by state. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. Access resources to help health care professionals do what they do bestcare for our members. If your state isn't listed, check out bcbs.com to find coverage in your area. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Prior authorizations are required for: All non-par providers. Inpatient services and nonparticipating providers always require prior authorization. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. The tool will tell you if that service needs . Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. It looks like you're outside the United States. If your state isn't listed, check out bcbs.com to find coverage in your area. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. We are also licensed to use MCG guidelines to guide utilization management decisions. All other available Medical Policy documents are published by policy/topic title. Your dashboard may experience future loading problems if not resolved. Our resources vary by state. We currently don't offer resources in your area, but you can select an option below to see information for that state. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. 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. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Enter a Current Procedural Terminology (CPT) code in the space below to get started. 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Interested in joining our provider network? Please note that services listed as requiring precertification may not be covered benefits for a member. We currently don't offer resources in your area, but you can select an option below to see information for that state. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. Provider Reimbursement Policies | Anthem.com Inpatient services and non-participating providers always 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. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services Medical policies can be highly technical and complex and are provided here for informational purposes.