JavaScript is disabled. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Type at least three letters and we will start finding suggestions for you. CPT Code Lookup, CPT Codes and Search - Codify by AAPC Members should contact their local customer service representative for specific coverage information. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Use our app, Sydney Health, to start a Live Chat. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. The medical policies do not constitute medical advice or medical care. 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. Members should contact their local customer service representative for specific coverage information. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. A group NPI cannot be used as ordering NPI on a Medicare claim. Call our Customer Service number, (TTY: 711). Understand your care options ahead of time so you can save time and money. Choose your location to get started. Choose your state below so that we can provide you with the most relevant information. 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. You can access the Precertification Lookup Tool through the Availity Portal. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. For a better experience, please enable JavaScript in your browser before proceeding. We currently don't offer resources in your area, but you can select an option below to see information for that state. Please update your browser if the service fails to run our website. You can also visit bcbs.com to find resources for other states. We currently don't offer resources in your area, but you can select an option below to see information for that state. ET. Use the Prior Authorization tool within Availity OR. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Choose your location to get started. All other available Medical Policy documents are published by policy/topic title. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. Explore our resources. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. Independent licensees of the Blue Cross Association. Click Submit. Our resources vary by state. If your state isn't listed, check out bcbs.com to find coverage in your area. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Prior authorization lookup tool| HealthKeepers, Inc. - Anthem The Blue Cross name and symbol are registered marks of the Blue Cross Association. We look forward to working with you to provide quality services to our members. These documents are available to you as a reference when interpreting claim decisions. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Independent licensees of the Blue Cross and Blue Shield Association. Use the Prior Authorization tool within Availity. Or Treating health care providers are solely responsible for diagnosis, treatment and medical advice. Medicaid renewals will start again soon. Use of the Anthem websites constitutes your agreement with our Terms of Use. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. Where is the Precertification Lookup Tool located on Availity? Explore programs available in your state. Our resources vary by state. Your dashboard may experience future loading problems if not resolved. 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. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Connecticut: Anthem Health Plans, Inc. Select Auth/Referral Inquiry or Authorizations. The resources on this page are specific to your state. Provider Medical Policies | Anthem.com Find information that's tailored for you. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Directions. Health Benefits for Federal Employees | Anthem Reimbursement Policies. 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). We look forward to working with you to provide quality service for our members. Available for iOS and Android devices. 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. We are also licensed to use MCG guidelines to guide utilization management decisions. The tool will tell you if that service needs . 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Access to the information does not require an Availity role assignment, tax ID or NPI. They are not agents or employees of the Plan. With Codify by AAPC cross-reference tools, you can check common code pairings. The notices state an overpayment exists and Anthem is requesting a refund. Access eligibility and benefits information on the Availity* Portal OR. To stay covered, Medicaid members will need to take action. The resources for our providers may differ between 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). Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans 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.). Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. We look forward to working with you to provide quality service for our members. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. Choose your location to get started. These guidelines do not constitute medical advice or medical care. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. 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. 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. There is no cost for our providers to register or to use any of the digital applications. In Kentucky: Anthem Health Plans of Kentucky, Inc. Provider Communications For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. Provider Communications 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. 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. Find drug lists, pharmacy program information, and provider resources. Taking time for routine mammograms is an important part of staying healthy. 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. Precertification lookup tool | Anthem 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. 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. You can also visit bcbs.com to find resources for other states. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. Your browser is not supported. Pay outstanding doctor bills and track online or in-person payments. In Indiana: Anthem Insurance Companies, Inc. 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") In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Health equity means that everyone has the chance to be their healthiest. Select a State Policies & Guidelines Medical Policies & Clinical UM Guidelines There are several factors that impact whether a service or procedure is covered under a member's benefit plan. Please update your browser if the service fails to run our website. 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. 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Your dashboard may experience future loading problems if not resolved. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Precertification Lookup Tool | Healthy Blue 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. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Providers | Tools, Resources & More | Anthem.com Your browser is not supported. 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. 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. Prior Authorization Lookup. 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. 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. Enter a CPT or HCPCS code in the space below. Attention: If you speak any language other than English, language assistance services, free of charge, are available to 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. 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. Medical policies can be highly technical and complex and are provided here for informational purposes. You are using an out of date browser. It looks like you're outside the United States. The resources for our providers may differ between states. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Members should discuss the information in the clinical UM guideline with their treating health care providers. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. 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. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Apr 1, 2022 The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Inpatient services and non-participating Anthem HealthKeepers Plus 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Inpatient services and non-participating providers always require prior authorization. Price a medication, find a pharmacy,order auto refills, and more. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Quickly and easily submit out-of-network claims online. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. We offer flexible group insurance plans for any size business. Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment, Indiana Medicaid Prior Authorization Requirements List, New Option Available for Indiana Market. 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. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. In Connecticut: Anthem Health Plans, Inc. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members.
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