Our resources vary by state. In Connecticut: Anthem Health Plans, Inc. You can access the Precertification Lookup Tool through the Availity Portal. Codify by AAPC helps you quickly and accurately select the CPT codes you need to keep your claims on track. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. 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 look forward to working with you to provide quality service for our members. Out-of-state providers. 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. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Your dashboard may experience future loading problems if not resolved. 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. You are using an out of date browser. We want to help physicians, facilities and other health care professionals submit claims accurately. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). 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. We update the Code List to conform to the most recent publications of CPT and HCPCS . You can also visit bcbs.com to find resources for other states. The resources for our providers may differ between states. Please update your browser if the service fails to run our website. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). 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. Directions. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. Contact will be made by an insurance agent or insurance company. In Ohio: Community Insurance Company. We currently don't offer resources in your area, but you can select an option below to see information for that state. It looks like you're in . 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. Search by keyword or procedure code for related policy information. Choose your location to get started. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. 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. Youll also strengthen your appeals with access to quarterly versions since 2011. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. 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. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Make your mental health a priority. 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. 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. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Medicaid renewals will start again soon. 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 discuss the information in the medical policies with their treating health care professionals. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Choose your state below so that we can provide you with the most relevant information. Copyright 2023. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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 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. The tool will tell you if that service needs . Explore our resources. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. New member? Please verify benefit coverage prior to rendering services. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Find drug lists, pharmacy program information, and provider resources. 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. 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. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Use of the Anthem websites constitutes your agreement with our Terms of Use. Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Your dashboard may experience future loading problems if not resolved. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. 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 Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Type at least three letters and we will start finding suggestions for you. Future updates regarding COVID-19 will appear in the monthly Provider News publication. In Connecticut: Anthem Health Plans, Inc. Additional medical policies may be developed from time to time and some may be withdrawn from use. Our call to Anthem resulted in a general statement basically use a different code. You must log in or register to reply here. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. Members should contact their local customer service representative for specific coverage information. The resources for our providers may differ between states. 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. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. In Maine: Anthem Health Plans of Maine, Inc. We are also licensed to use MCG guidelines to guide utilization management decisions. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. 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. Medical policies can be highly technical and complex and are provided here for informational purposes. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. It looks like you're outside the United States. Find answers to all your questions with an Anthem representative in real time. Please Select Your State The resources on this page are specific to your state. Use the Prior Authorization tool within Availity OR. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. For a better experience, please enable JavaScript in your browser before proceeding. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Taking time for routine mammograms is an important part of staying healthy. 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 verify benefit coverage prior to rendering services. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. We currently don't offer resources in your area, but you can select an option below to see information for that state. All other available Medical Policy documents are published by policy/topic title. Our resources vary by state. It looks like you're in . Our resources vary by state. Pay outstanding doctor bills and track online or in-person payments. Where is the Precertification Lookup Tool located on Availity? We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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.
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