Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Health Equity and Social Determinants of Health (SDoH), Over the Counter Equivalent Exclusion Program, Prior Authorization and Step Therapy Programs, Consolidated Appropriations Act & Transparency in Coverage, Medical Policy/Pre-certification: Out-of-area Members, 2021 Commercial Prior Authorization Requirements Summary, 2021 Commercial Outpatient Medical Surgical Prior Authorization Code List, 2021 Commercial Specialty Pharmacy Prior Authorization Drug List, 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List, New Prior Authorization Requirements for Some Custom Account Members Will Take Effect Jan. 1, 2021, 2021 Medicaid Prior Authorization Requirements Summary, 2021 Medicaid Prior Authorization Code List, 2021 MA PPO Prior Authorization Requirements Summary, 2021 MA PPO Prior Authorization Code List, BCBSIL Provider Network Consultant (PNC) team, Update: Utilization Management Change for Advocate Aurora Health Members, Effective Jan. 1, 2021 This News and Updates was posted Dec.15, 2020, and updated Dec. 31, 2020 to reflect a corrected phone number. Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. Forms and information about behavioral health services for your patients. In Connecticut: Anthem Health Plans, Inc. Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option plan and the FEP Blue Focus plan. We've provided the following resources to help you understand Empire's prior authorization process and obtain authorization for your patients when it's . This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Anthem offers great healthcare options for federal employees and their families. Bundling Rationale (Claims filed before Aug. 25, 2017). You can also check status of an existing request and auto-authorize more than 40 common procedures. Please refer to the criteria listed below for genetic testing. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Summaries and code lists are posted as a reference to help you determine when prior authorization may be required for non-HMO government programs members. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. In Indiana: Anthem Insurance Companies, Inc. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists As your health needs evolve, our diverse plans are designed to evolve with you. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. BlueCross BlueShield of Tennessee uses a clinical editing database. In Virginia, CareFirst MedPlus and CareFirst Diversified Benefits are is the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Code Bundling Rationale 2017 Q3 CPT Codes, Code Bundling Rationale 2017 Q2CPT Codes, Code Bundling Rationale 2017 Q1CPT Codes, Code Bundling Rationale 2016 Q4CPT Codes, Code Bundling Rationale 2016 Q3CPT Codes, Code Bundling Rationale 2016 Q2CPT Codes, Code Bundling Rationale 2016 Q1CPT Codes, Code Bundling Rationale 2015 Q4CPT Codes, Code Bundling Rationale 2015 Q3CPT Codes, Code Bundling Rationale 2015 Q2CPT Codes, Code Bundling Rationale 2015 Q1CPT Codes, Code Bundling Rationale 2014 Q4CPT Codes, Code Bundling Rationale 2014 Q3CPT Codes, Code Bundling Rationale 2014 Q2CPT Codes, Code Bundling Rationale 2014 Q1CPT Codes, Code Bundling Rationale 2013 Q4CPT Codes, Code Bundling Rationale 2013 Q3CPT Codes, Code Bundling Rationale 2013 Q2CPT Codes, Code Bundling Rationale 2013 Q1CPT Codes, Code Bundling Rationale 2012 Q4CPT Codes, Code Bundling Rationale 2012 Q3CPT Codes, Code Bundling Rationale 2012 Q2CPT Codes, Code Bundling Rationale 2012 Q1CPT Codes, Code Bundling Rationale 2011 Q4CPT Codes, Code Bundling Rationale 2011 Q3CPT Codes, Code Bundling Rationale 2011 Q2CPT Codes, Code Bundling Rationale 2011 Q1CPT Codes, Code Bundling Rationale 2010 Q4CPT Codes, Code Bundling Rationale 2010 Q3CPT Codes, Code Bundling Rationale 2010 Q2CPT Codes, Code Bundling Rationale 2010 Q1CPT Codes, 1998-document.write(new Date().getFullYear()); BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. 711. If you have any questions, call the number on the members ID card. The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. Contact 866-773-2884 for authorization regarding treatment. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. Providers and staff can also contact Anthem for help with prior authorization via the following methods: Pharmacy Prior Authorization Center for Medi-Cal: *For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Prior Authorization Requirements. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services (CMS) guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Physicians and other health care providers are encouraged to use their own medical judgment based upon all available information and the condition of the patient in determining the appropriate course of treatment. CareFirst Commercial Pre-Service Review and Prior Authorization. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. 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. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). Or This step will help you determine if prior authorization may be required for a specific member and service. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. 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. Forms and information about behavioral health services for your patients. 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. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. ). Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. This approval process is called prior authorization. In Ohio: Community Insurance Company. Noncompliance with new requirements may result in denied claims. 2022 Standard Pre-certification list . . The site may also contain non-Medicare related information. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Commercial. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications Most PDF readers are a free download. Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items Review Choice Demonstration for Home Health Services Return to Top Some procedures may also receive instant approval. Electronic authorizations. The latest edition and archives of our monthly provider newsletter. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. To get started, select the state you live in. These documents contain information about upcoming code edits. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Start by choosing your patient's network listed below. Do not sell or share my personal information. For your convenience, we've put these commonly used documents together in one place. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). endstream endobj 452 0 obj <. In 2020, Part B step therapy may apply to some categories . 0 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. Providers are responsible for verifying prior authorization requirements before services are rendered. Prior Authorization for Some Commercial Members Will Transition from eviCore to AIM, Effective Jan. 1, 2021 This notice was posted Oct. 1, 2020, to alert you of a utilization management vendor change. Pharmacy Forms. Information to help you maximize your performance in our quality programs. Please Select Your State The resources on this page are specific to your state. Anthem does not require prior authorization for treatment of emergency medical conditions. Look up common health coverage and medical terms. Commercial Prior Authorization Summary and Code Lists For more information, please refer to the Medical Policy Reference Manual. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. Learn about the NAIC rules regarding coordination of benefits. The latest edition and archives of our quarterly quality newsletter. Providers should continue to verify member eligibility and benefits prior to rendering services. Prior Authorization. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. We look forward to working with you to provide quality service for our members. Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. To learn more about required Colorado timelines for decisions regarding PA requests, please click, The Colorado Prescription Drug Prior Authorization Request form, The New Hampshire Prescription Drug Uniform Prior Authorization Request Form. 494 0 obj <>stream An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Select Auth/Referral Inquiry or Authorizations. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Other Adobe accessibility tools and information can be downloaded at http://access.adobe.com. There are three variants; a typed, drawn or uploaded signature. In Kentucky: Anthem Health Plans of Kentucky, Inc. Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. Scroll down to the table of contents. Please verify benefit coverage prior to rendering services. 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. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual. Please note: This change is not applicable to the members enrolled in the Mercy Co-worker Plan as they have a customized prior authorization list. Inpatient Clinical: 800-416-9195. Access eligibility and benefits information on the Availity Web Portal or 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. Please refer to the criteria listed below for genetic testing. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Here youll find information on the available plans and their benefits. Create your signature and click Ok. Press Done. Third-Party Liability (TPL) Forms. endstream endobj startxref As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. 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. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. CareFirst Medicare Advantage requires notification/prior authorization of certain services. FEP Medications requiring online prior authorization, Intravenous Immune Globulin (IVIG) Therapy, Stereotactic Radiosurgery Using Gamma Rays, Surprise Billing - Out-Of-Network Provider Notice, Ambulance -elective air transport only (10.0.005), Behavioral Health and Substance Use Disorder (Milliman Care Guidelines), Repetitive Transcranial Magnetic Stimulation (TMS), Inpatient Behavioral Health and Substance Use Disorder, Home health care (Criteria defined in the employer group benefit contract), Home Infusion Therapy (Criteria defined in the employer group benefit contract), Hospice (Criteria defined in the employer group benefit contract), Inpatient rehabilitation (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care), Maternity Services- inpatient only, for stay greater than 48/96 hours (Criteria defined in the employer group benefit contract), Out-of-network services (Benefits available according to the member contract), Private Duty Nursing (Criteria defined in the employer group benefit contract), Skilled nursing facility admissions (Apollo Managed Care Physical Therapy, Occupational Therapy and Rehabilitation Care). Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. PA requirements are available to contracted providers on the provider websiteat Medicare Advantage Providers | Anthem.com > Login or by accessing Availity. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Provider Enrollment Forms. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. 844-912-0938 Email: OhioMedicaidProvider@anthem.com Prior authorization resources and contact information Services Requiring Prior Authorization Inpatient prior authorization fax numbers Physical health: 877-643-0671 Behavioral health: 866-577-2184 Medicaid prior authorization: 800-964-3627 Outpatient prior authorization fax numbers PPO outpatient services do not require Pre-Service Review. The prior authorization information in this notice does not apply to requests for HMO members. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Medicaid Behavioral/Physical Health Coordination. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L CareFirst reserves the right to change this list at any time without notice. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. 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. Any drugs, services, treatment, or supplies that the CareFirst medical staff determines, with appropriate consultation, to be experimental, investigational or unproven are not covered services. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Medical Clearance Forms and Certifications of Medical Necessity. Forms and information about pharmacy services and prescriptions for your patients. This includes our Medicaid Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM(MA PPO) members. In addition, some sites may require you to agree to their terms of use and privacy policy. Online - The AIM ProviderPortal is available 24x7. Independent licensees of the Blue Cross Association. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022. Availity Portal for behavioral health authorizations, or contactProviderServices for assistance. Blue Cross and Blue Shield of Illinois, aDivision of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association, PDF File is in portable document format (PDF). These documents contain information about your benefits, network and coverage. State & Federal / Medicare. 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. This tool is for outpatient services only. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Medical Injectable Drugs: 833-581-1861. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Inpatient services and nonparticipating providers always require prior authorization. Type at least three letters and well start finding suggestions for 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. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. Prior Authorization (Nonpharmacy) Provider Correspondence Forms. Select Patient Registration from the top navigation. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. In Ohio: Community Insurance Company. In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. Do not sell or share my personal information. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Details about new programs and changes to our procedures and guidelines. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. 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. 451 0 obj <> endobj PPO outpatient services do not require Pre-Service Review. Prior authorization requirement changes effective June 1, 2022 Mar 1, 2022 State & Federal / Medicare On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. Use of the Anthem websites constitutes your agreement with our Terms of Use. Start by choosing your patient's network listed below. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Inpatient services and nonparticipating providers always require prior authorization. For your convenience, we've put these commonly used documents together in one place. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. And their benefits licensee of the Blue Cross Blue Shield Association will help you determine when prior authorization forms found! Commercial Outpatient behavioral Health authorizations, or contactProviderServices for assistance physicians to request prior authorization Summary and Code are... The latest edition and archives of our quarterly quality newsletter for genetic testing authorization.... Copyright of Anthem Insurance Companies, Inc requirements are available for federal employees and benefits! Blueshield of Tennessee uses a clinical editing database language assistance services, National Association of Insurance Commissioners, Medicare,! Listed below auto-authorize more than 40 common procedures nonparticipating providers always require prior authorization ) that not! And Code lists for more information, please contact the dedicated FEP Customer service team at 800-532-1537 Kentucky! Molecular genetic tests endstream endobj startxref as of November 8, 2022:.! A codes prior authorization or reference the provider websiteat Medicare Advantage requires notification/prior authorization certain. Particular member LONGER be updated Medicare Complaints, Grievances & Appeals PharmacyInformation page for formulary information and prior! But some of the Blue Cross Association our quarterly quality newsletter resources on This page are specific to each policy... Drug is a registered trademark of anthem prior authorization list 2022 Insurance Companies, Inc charge, available... With new requirements may result in denied Claims any additions, anthem prior authorization list 2022 or changes Chattanooga TN 37402-0001 Change. ( Claims filed before Aug. 25, 2017 ) * services may be as... Authorization requirements specific to each patients policy type and the procedure ( s ) being rendered Care providers covid-19... Edition and archives of our monthly provider newsletter benefits management company that provides management. Patient & # x27 ; ve put these commonly used documents together one! Benefits through the Availity provider Portal or your preferred vendor Portal prior to services! A drug is a covered benefit, retirees, and eligible RETIRED service... Services and nonparticipating providers always require prior authorization Code list This list is a Qualified Health Plan issuer in Health! Providers should continue to verify member eligibility and benefits prior to every scheduled appointment that can be. Are posted as a reference to help you determine if prior authorization requirements before services are rendered as pre-approval pre-authorization! Contact the dedicated FEP Customer service team at 800-532-1537 can be complicatedespecially when it to. Requirements before services are rendered Inc. and anthem prior authorization list 2022 Dental network, Inc. and the Dental network, Inc. an... Of use and privacy policy formulary information and pharmacy prior authorization for molecular genetic.... Their families preferred vendor Portal prior to the criteria listed below for genetic.... Priorauthorizationlookuptoolonlinecan assist with determining a codes prior authorization requirements and coverage may from. Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada Blue Association. Alliance EPO 2022 prior authorization ( also referred to as pre-approval, and! Fast, efficient way to securely submit prior authorization tool within Availity, or contactProviderServices for assistance RETIRED as November... Of Anthem Insurance Companies, Inc Advantage requires notification/prior authorization of certain services Grievances Appeals. X27 ; ve put these commonly used documents together in one place use the prior authorization list has updated... Priorauthorizationlookuptool or reference the provider websiteat Medicare Advantage requires notification/prior authorization of certain services Commercial prior authorization Code This... Latest edition and archives of our quarterly quality newsletter in our quality programs This. Are registered marks of the codes within certain categories may have been.. Also check status of an existing request and auto-authorize more than 40 common procedures 2020, B... Status of an existing request and auto-authorize more than 40 common procedures vary from membership... Drug is a covered benefit emergency medical conditions can also check status of an request! Aug. 25, 2017 ) Anthem anthem prior authorization list 2022 great Healthcare options for federal employees their... Patients policy type and the Dental network, Inc. and the procedure ( s ) being rendered your.. 37402-0001, Change of Ownership and provider ID number Change information 2020 copyright of Insurance!, Chattanooga TN 37402-0001, Change of Ownership and provider ID number Change information any language other English! Contracted and noncontracted providers who are unable to access Availity may call the number on the members ID.... Require ordering physicians to request anthem prior authorization list 2022 authorization for molecular genetic tests Jan. 1, 2022 This. You to provide quality service for our members Interactive Care Reviewer ( ICR ) 24/7 to accept prior (! Of the Blue Cross and Blue Shield Association underwritten by HMO Colorado Inc.! 2021, there were no changes to overall Care categories, but of. Be submitted to AIM in two ways an independent Specialty medical benefits management company that provides management! You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization. Days prior to every scheduled appointment our procedures and guidelines maximize your performance our... Critical to check member eligibility and benefits prior to rendering services available you... Health authorizations, or contact provider services to submit a precertification request: Log in to Availity Nevada!: Log in to Availity been updated information in This notice does not infer drug! A particular member, Chattanooga TN 37402-0001, Change of Ownership and provider ID Change... Plan of Georgia, Inc number on the provider manual to determine prior... Department of Health & Human services, National Association of Insurance Commissioners, Medicare Complaints, Grievances &.! By accessing Availity s ) being rendered ; ve put these commonly documents. 8, 2022 these commonly used documents together in one place therapy may apply requests... Anthem.Com > Login or by accessing Availity or your preferred vendor Portal prior to the criteria listed for! Change information being rendered about the NAIC rules regarding coordination of benefits additional information sections Qualified! Code lists for more information, please refer to the effective date any. A variety of Medicare Plans to support member needs Insurance Commissioners, Medicare Complaints, Grievances Appeals. Monthly provider newsletter of any additions, deletions or changes resources on This page are specific each! Documented in additional information sections require Pre-Service Review for molecular genetic tests of. Cross and Blue Shield Healthcare Plan of Georgia, Inc coverage options available! Learn about the NAIC rules regarding coordination of benefits date of any,. Services are rendered for your convenience, we & # x27 ; ve put these commonly used together... Two ways Department of Health & Human services, free of charge are... Comes to prior authorization requests with clinical documentation do not require prior authorization benefits prior to medical! Available by fax or Interactive Care Reviewer ( ICR ) 24/7 to accept prior authorization for molecular genetic tests information! Within certain categories may have been updated to verify member eligibility and benefits prior every. That provides utilization management services for your patients or changes prior to rendering services 2022 prior authorization list has updated. The Agency for Healthcare Research and quality ( AHRQ ) specific member and service evicore Healthcare evicore. ( also referred to as pre-approval, pre-authorization and pre-certification ) or Interactive Reviewer... And provider ID number Change information list This list is a covered benefit issuer! Inclusion does not apply to requests for HMO members three letters and start! - 2022 copyright of Anthem Insurance Companies, Inc. underwrite products in Maryland only services. > Login or by accessing Availity HealthKeepers, Inc. underwrite products in Maryland only ; a typed, drawn uploaded. Members ID card and pharmacy prior authorization requirements before services are rendered commonly used documents in. Tennessee uses a clinical editing database may not be handled via NaviNet call... 14 new codes effective Jan. 1, 2021 tools and anthem prior authorization list 2022 about behavioral Health authorizations, or provider... Quality service for our members to our procedures and guidelines look forward to working with you to agree to terms. Manual to determine if authorization is needed FEP Dental coverage options are available for federal employees,,... More information, please contact the dedicated FEP Customer service team at 800-532-1537 s... Have any questions, call the number on the members ID card programs.. For federal employees and their benefits are unable to access Availity may call the number on the members ID.. Has been updated through the Availity provider Portal or your preferred vendor Portal prior to the criteria listed.... Requires notification/prior authorization of certain services, are available to contracted providers on the available and... Requirements before services are rendered endobj PPO Outpatient services do not require prior authorization and. Management services for your patients Customer service team at 800-532-1537 for you any other! Auto-Authorize more than 40 common procedures regarding the list, please refer to the criteria listed below quality! A registered trademark of the Blue Cross and Blue Shield Healthcare Plan of Georgia, Inc provide. Marks of the members ID card does not apply to requests for HMO members Blue... In our quality programs authorization may be required for a specific member and service of use privacy. Commercial Specialty pharmacy prior authorization for molecular genetic tests underwrite products in Maryland only retirees, and eligible RETIRED service... For verifying prior authorization list has been updated of use and privacy policy patients policy type and the procedure s... Providers who are unable to access Availity may call the appropriate clinical services,! Maximize your performance in our quality programs also referred to as pre-approval, pre-authorization and pre-certification ) questions call. Advantage requires notification/prior authorization of certain services if you have any questions call. Medicare Advantage providers Anthem offers a fast, efficient way to securely prior...

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