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. 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. Future updates regarding COVID-19 will appear in the monthly Provider News publication. In Kentucky: Anthem Health Plans of Kentucky, Inc. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. 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. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. In Maine: Anthem Health Plans of Maine, Inc. Member benefit lookup by procedure code - Anthem 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. 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. New member? Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. 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. In Ohio: Community Insurance Company. Prior authorization lookup tool | Blue Cross MN Medicare Complaints, Grievances & Appeals. Question Anthem Commercial Policy of Wisconsin Consultation Codes - AAPC The resources for our providers may differ between states. 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. 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 currently don't offer resources in your area, but you can select an option below to see information for that state. You can access the Precertification Lookup Tool through the Availity Portal. We currently don't offer resources in your area, but you can select an option below to see information for that state. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. You can also visit. Understand your care options ahead of time so you can save time and money. 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. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 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. Please note that services listed as requiring precertification may not be covered benefits for a member. 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. Provider Communications To stay covered, Medicaid members will need to take action. Administrative / Digital Tools, Learn more by attending this live webinar. This tool is for outpatient services only. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. We look forward to working with you to provide quality service for our members. 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. Our resources vary by state. Provider Communications Please update your browser if the service fails to run our website. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We look forward to working with you to provide quality service for our members. 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. In Indiana: Anthem Insurance Companies, Inc. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. 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. We look forward to working with you to provide quality services to our members. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Search by keyword or procedure code for related policy information. Our resources vary by state. It looks like you're in . In Connecticut: Anthem Health Plans, Inc. We currently don't offer resources in your area, but you can select an option below to see information for that state. We are also licensed to use MCG guidelines to guide utilization management decisions. The medical policies do not constitute medical advice or medical care. Medicare and some payers may allow providers of different specialties to report initial hospital services and require the admitting/supervising provider to append modifier AI. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Precertification Lookup Tool | Healthy Blue We update the Code List to conform to the most recent publications of CPT and HCPCS . You are using an out of date browser. Large Group To get started, select the state you live in. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). Find out if a service needs prior authorization. You can access the Precertification Lookup Tool through the Availity Portal. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. Out-of-state providers. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Please verify benefit coverage prior to rendering services. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. For subsequent inpatient care, see 99231-99233. 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). In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. We have developed medical policies that serve as one of the sets of guidelines for coverage decisions. Please verify benefit coverage prior to rendering services. Here you'll find information on the available plans and their benefits. 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 clinical UM guidelines. Or The resources for our providers may differ between states. Price a medication, find a pharmacy,order auto refills, and more. Choose your state below so that we can provide you with the most relevant information. 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. Our research shows that subscribers using Codify by AAPC are 33% more productive. We currently don't offer resources in your area, but you can select an option below to see information for that state. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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). Find a Medicare plan that fits your healthcare needs and your budget. Reason Code 16 | Remark Codes MA13 N265 N276 - JA DME