Choose your state below so that we can provide you with the most relevant information. Your browser is not supported. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. 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. We update the Code List to conform to the most recent publications of CPT and HCPCS . 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Understand your care options ahead of time so you can save time and money. Independent licensees of the Blue Cross Association. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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). As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. These documents are available to you as a reference when interpreting claim decisions. We currently don't offer resources in your area, but you can select an option below to see information for that state. For a better experience, please enable JavaScript in your browser before proceeding. Please verify benefit coverage prior to rendering services. Use of the Anthem websites constitutes your agreement with our Terms of Use. Directions. 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. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Provider Medical Policies | Anthem.com Find information that's tailored for you. Our resources vary by state. Large Group 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 deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Anthem offers great healthcare options for federal employees and their families. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. In Ohio: Community Insurance Company. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. 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. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. 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. 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. The resources for our providers may differ between states. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. This tool is for outpatient services only. Members should contact their local customer service representative for specific coverage information. The purpose of this communication is the solicitation of insurance. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. 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. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Use our app, Sydney Health, to start a Live Chat. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Your dashboard may experience future loading problems if not resolved. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Were committed to supporting you in providing quality care and services to the members in our network. No provider of outpatient services gets paid without reporting the proper CPT codes. 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. 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. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Use of the Anthem websites constitutes your agreement with our Terms of Use. Choose your location to get started. Independent licensees of the Blue Cross and Blue Shield Association. 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. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. Understand your care options ahead of time so you can save time and money. To stay covered, Medicaid members will need to take action. 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. Youll also strengthen your appeals with access to quarterly versions since 2011. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. The Precertification Lookup Tool will let you know if clinical edits apply, information such as the medical necessity criteria used in making the authorization decision, and if a vendor is used -- without the need to make a phone call. Choose your location to get started. 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. You can also visit bcbs.com to find resources for other states. Our resources vary by state. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). The resources for our providers may differ between states. For costs and complete details of the coverage, please contact your agent or the health plan. Compare plans available in your area and apply today. Current Procedural Terminology, more commonly known as CPT, refers to a medical code set created and maintained by the American Medical Association and used by physicians, allied health professionals, nonphysician practitioners, hospitals, outpatient facilities, and laboratories to represent the services and procedures they perform. New member? Other ways to access: If you are currently accessing the Pre-certification / Pre-Authorization Requirements list through your health plans public website, this option is still available for you. 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. It looks like you're in . Inpatient services and nonparticipating providers always require prior authorization. Where is the Precertification Lookup Tool located on Availity? Inpatient services and nonparticipating providers always require prior authorization. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Type at least three letters and well start finding suggestions for you. Choose your state below so that we can provide you with the most relevant information. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Start a Live Chat with one of our knowledgeable representatives. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Interested in joining our provider network? This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) 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. The resources for our providers may differ between states. Your dashboard may experience future loading problems if not resolved. Your browser is not supported. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. We currently don't offer resources in your area, but you can select an option below to see information for that state. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Select Your State We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. In Maine: Anthem Health Plans of Maine, Inc. 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. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. 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. Independent licensees of the Blue Cross and Blue Shield Association. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. There is no cost for our providers to register or to use any of the digital applications. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Access eligibility and benefits information on the Availity* Portal OR. Members should discuss the information in the clinical UM guideline with their treating health care providers. Prior authorization lookup tool| HealthKeepers, Inc. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Type at least three letters and we will start finding suggestions for you. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. 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. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield.

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