Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Large Group They are not agents or employees of the Plan. Pay outstanding doctor bills and track online or in-person payments. State & Federal / Medicaid. Self-Service Tools 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. 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. Please verify benefit coverage prior to rendering services. 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 In Connecticut: Anthem Health Plans, 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. In Ohio: Community Insurance Company. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. 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. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. If your state isn't listed, check out bcbs.com to find coverage in your area. These documents are available to you as a reference when interpreting claim decisions. Our call to Anthem resulted in a general statement basically use a different code. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Prior authorizations are required for: All non-par providers. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. 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. Plus, you may qualify for financial help to lower your health coverage costs. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. 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. Please verify benefit coverage prior to rendering services. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. Vaccination is important in fighting against infectious diseases. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. Here you'll find information on the available plans and their benefits. Providers | Tools, Resources & More | Anthem.com Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. Inpatient services and nonparticipating providers always require prior authorization. Members should contact their local customer service representative for specific coverage information. In Indiana: Anthem Insurance Companies, Inc. Provider Communications * Services may be listed as requiring precertification that may not be covered benefits for a particular member. Use of the Anthem websites constitutes your agreement with our Terms of Use. Provider Communications Choose your location to get started. It may not display this or other websites correctly. We look forward to working with you to provide quality services to our members. 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). Prior authorization lookup tool| HealthKeepers, Inc. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Access eligibility and benefits information on the Availity* Portal OR. 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. Lets make healthy happen. For a better experience, please enable JavaScript in your browser before proceeding. We look forward to working with you to provide quality services to our members. You can access the Precertification Lookup Tool through the Availity Portal. Prior-Authorization And Pre-Authorization | Anthem.com You can also visit bcbs.com to find resources for other states. You can also visit. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. The Blue Cross name and symbol are registered marks of the Blue Cross Association. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services Your online account is a powerful tool for managing every aspect of your health insurance plan. In Indiana: Anthem Insurance Companies, Inc. Available for iOS and Android devices. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. 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. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. Type at least three letters and well start finding suggestions for you. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. 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. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Use the Prior Authorization tool within Availity OR. We offer affordable health, dental, and vision coverage to fit your budget. 711. Please update your browser if the service fails to run our website. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. If youre concerned about losing coverage, we can connect you to the right options for you and your family. Our resources vary by state. We want to help physicians, facilities and other health care professionals submit claims accurately. Reason Code 16 | Remark Codes MA13 N265 N276 - JA DME In Maine: Anthem Health Plans of Maine, Inc. 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. We look forward to working with you to provide quality service for our members. 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. 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. A group NPI cannot be used as ordering NPI on a Medicare claim. 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. Contact will be made by an insurance agent or insurance company. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. 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. Precertification Lookup Tool | Healthy Blue Independent licensees of the Blue Cross and Blue Shield Association. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). For subsequent inpatient care, see 99231-99233. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. In Maine: Anthem Health Plans of Maine, Inc. The resources for our providers may differ between states. Apr 1, 2022 Were committed to supporting you in providing quality care and services to the members in our network. Our resources vary by state. Youll also strengthen your appeals with access to quarterly versions since 2011. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Your dashboard may experience future loading problems if not resolved.
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