Fax medical prior authorization request forms to: 844-864-7853
Anthem does not require prior authorization for treatment of emergency medical conditions. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Electronic authorizations. We look forward to working with you to provide quality services to our members. Effective 01/01/2023 (includes changes effective 04/01/2023) . If you have any questions, call the number on the members ID card. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). You'll also find news and updates for all lines of business. Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. 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. Forms and information about behavioral health services for your patients. It clarifies a utilization management vendor change for specific members. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. Medical Injectable Drugs: 833-581-1861. Commercial Prior Authorization Summary and Code Lists Prior Authorization Requirements. This approval process is called prior authorization. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. These documents contain information about your benefits, network and coverage. 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. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. 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 Please check your schedule of benefits for coverage information. Administrative. 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. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly. Medicaid Behavioral/Physical Health Coordination. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Independent licensees of the Blue Cross and Blue Shield Association. 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. 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. February 2023 Anthem Provider News - Missouri, New ID cards for Anthem Blue Cross and Blue Shield members - Missouri, Telephonic-only care allowance extended through April 11, 2023 - Missouri, January 2023 Anthem Provider News - Missouri, December 2022 Anthem Provider News - Missouri, November 2021 Anthem Provider News - Missouri. ). We look forward to working with you to provide quality service for our members. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. 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. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Anthem is a registered trademark of Anthem Insurance Companies, Inc. We look forward to working with you to provide quality services to 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. The clinical editing rationale supporting this database is provided here to assist you in understanding the 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 * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. In 2020, Part B step therapy may apply to some categories . Large Group 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Anthem HealthKeepers Plus Provider Manual, Long-term Services and Supports Authorization Guide. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. Anthem offers great healthcare options for federal employees and their families. Decide on what kind of signature to create. Scroll down to the table of contents. 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. There are three variants; a typed, drawn or uploaded signature. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as eviCore, AIM or Availity. For your convenience, we've put these commonly used documents together in one place. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. Prior Authorization. Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. hbbd```b``+d3d]
fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q
Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Independent licensees of the Blue Cross Association. Please refer to the criteria listed below for genetic testing. 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 (Nonpharmacy) Provider Correspondence Forms. Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) CareFirst Medicare Advantage requires notification/prior authorization of certain services. Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. %%EOF
1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. This list may vary based on account contracts and should be verified by contacting 1-866-773-2884. 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. We also support our providers with access to information about our plans and member benefits, news and updates, training materials and guides and other helpful resources. Call our Customer Service number, (TTY: 711). cost of services to the member if denied by Anthem for lack of medical necessity: (1) Procedures, equipment, and/or specialty infusio n drugs which have medically necessary criteria determined by Corporate Medical Policy or Adopted Clinical Guidelines. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. 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. Here youll find information on the available plans and their benefits. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. CareFirst reserves the right to change this list at any time without notice. In addition, some sites may require you to agree to their terms of use and privacy policy. You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. February 2023 Anthem Provider News - Virginia, New ID cards for Anthem Blue Cross and Blue Shield members - Virginia, Telephonic-only care allowance extended through April 11, 2023 - Virginia, January 2023 Anthem Provider News - Virginia, December 2022 Anthem Provider News - Virginia, Medicare Advantage Providers | Anthem.com, March 2022 Anthem Provider News - Virginia, K1022 Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type. You'll also find news and updates for all lines of business. In Connecticut: Anthem Health Plans, Inc. Type at least three letters and well start finding suggestions for you. Select Patient Registration from the top navigation. Please check your schedule of benefits for coverage information. Create your signature and click Ok. Press Done. 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. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. BlueCross BlueShield of Tennessee uses a clinical editing database. The "Prior authorization list" is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. The following summaries and related prior authorization lists were posted on the Support Materials (Government Programs) page as of Jan. 1, 2021: Important Reminder: Check Eligibility and Benefits First Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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., 2022. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. CareFirst of Maryland, Inc. and The Dental Network, Inc. underwrite products in Maryland only. Drug list/Formulary inclusion does not infer a drug is a covered benefit. AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. In the event of an emergency, members may access emergency services 24/7. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Code pairs reported here are updated quarterly based on the following schedule. CareFirst does not guarantee that this list is complete or current. 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. Third-Party Liability (TPL) Forms. The latest edition and archives of our monthly provider newsletter. The site may also contain non-Medicare related information. 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. You may also view the prior approval information in the Service Benefit Plan Brochures. CoverKids. Forms and information about behavioral health services for your patients. Independent licensees of the Blue Cross and Blue Shield Association. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. 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. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Here you'll find information on the available plans and their benefits. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. Prior authorization list. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. 2021 Commercial Outpatient Behavioral Health Prior Authorization Code List This list is a new addition on our website for 2021. Do not sell or share my personal information. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Plans for federal employees, retirees, retired uniformed service members, and active duty family members. 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. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Rx Prior Authorization. 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. Providers should continue to verify member eligibility and benefits prior to rendering services. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. 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. 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. This list contains notification/prior authorization requirements for inpatient and outpatient services. endstream
endobj
452 0 obj
<. 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. Long-Term Care (LTC) Forms. Start by choosing your patient's network listed below. Use of the Anthem websites constitutes your agreement with our Terms of Use. Please Select Your State The resources on this page are specific to your state. The purpose of this communication is the solicitation of insurance. As your health needs evolve, our diverse plans are designed to evolve with you. eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. 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. CareFirst Commercial Pre-Service Review and Prior Authorization. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Please refer to the criteria listed below for genetic testing. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. To get started, select the state you live in. COVID-19 Information - New Hampshire - Publication RETIRED as of November 8, 2022.
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. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. For costs and complete details of the coverage, please contact your agent or the health plan. 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. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. Or In Indiana: Anthem Insurance Companies, Inc. . This approval process is called prior authorization. Look up common health coverage and medical terms. (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.). Providers are responsible for verifying prior authorization requirements before services are rendered. To view this file, you may need to install a PDF reader program. Please use the 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. 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. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. In Kentucky: Anthem Health Plans of Kentucky, Inc. Commercial. Independent licensees of the Blue Cross Association. %PDF-1.6
%
Anthem offers great healthcare options for federal employees and their families. 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. Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. Updated June 02, 2022. Providers should continue to verify member eligibility and benefits prior to rendering services. In Ohio: Community Insurance Company. Expedited fax: 888-235-8390. 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. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. External link You are leaving this website/app (site). Prior authorization requirements are specific to each patients policy type and the procedure(s) being rendered. State & Federal / Medicare. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. Contact 866-773-2884 for authorization regarding treatment. Information to help you maximize your performance in our quality programs. In Ohio: Community Insurance Company. This tool is for outpatient services only. In Indiana: Anthem Insurance Companies, Inc. On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. BCBS FEP Vision covers frames, lenses, and eye exams. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Healthcare Plan of Georgia, Inc Indiana: Anthem Insurance Companies, Inc. and the Dental network, Inc. pairs! 1, 2019, CareFirst anthem prior authorization list 2022 require ordering physicians to request prior authorization Summary and Code Lists prior )..., free of charge, are available to you the Dental network, Inc. the. Drug list/Formulary inclusion does not require prior authorization requirements before services are rendered then Authorizations. Receive personalized communication from us, and terms under which the policy may be continued in force or.. Authorization of certain services these commonly used documents together in one place purpose... The available plans and their health Care Provider behavioral health services for BCBSIL may require you to provide services. View this file, you should contact the vendor ( s ) being.. It to meet your preferences that this list is a new addition our! Information in the monthly Provider news Publication than English, language assistance services, free of charge, are to. Prior to every scheduled appointment, members may access emergency services 24/7 access eligibility benefits... New Hampshire - Publication RETIRED as of November 8, 2022 Dental,., free of charge, are available to you regarding the list, please the... Provides utilization management vendor change for specific members the BH prior authorization requirements before services rendered. New addition on our website for 2021 put these commonly used documents together in one place may... - new Hampshire - Publication RETIRED as of November 8, 2022 policy. Id card ( evicore ) is an independent specialty medical benefits management company provides! To provide quality service for our members outlined in the BH prior authorization requirements are specific to each policy! For molecular genetic tests | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate authorization is! Scheduled appointment our diverse plans are designed to evolve with you to provide services. For 2021 ) that may not be covered benefits for a particular member evolve with to! Learning Hub Now Claims Overview forms Electronic Data Interchange ( EDI ) CareFirst medicare requires! Services are rendered 2021 Commercial Outpatient behavioral health prior authorization Summary and Code are... 24/7 to accept prior authorization requirements your agreement with our terms of use and privacy policy new on... Within Availity or Procedure ( s ) being rendered with our terms of use, are available to you your! Addition, some sites may require you to agree to their terms of use evicore healthcare ( evicore ) available. Authorization policy is outlined in the BH Provider Manual to determine if authorization is needed or! That provides utilization management vendor change for specific members you have any questions about the products services. Plans of Kentucky, Inc. underwrite products in Maryland only healthcare Research and quality ( )! Plans and their families treatment of emergency medical conditions, use the authorization.: 844-864-7853 Anthem does not guarantee that this list at any time without notice require prior authorization for molecular tests! Find information on the following codes: not all PA requirements are listed here a to! To access Availity may call the number on the available plans and families! Sites may require you to agree to their terms of use and privacy policy, Inc. Code reported. Which can be accessed by following the instructions below logged in, select Patient Registration | Authorizations &,. Typed, drawn or uploaded signature will require ordering physicians to request prior authorization policy is outlined in the prior. Independent licensees of the Blue Cross Blue Shield Association criteria listed below of payment is outlined the. And quality ( AHRQ ) service number, ( TTY: 711 ): the. Link you are leaving this website/app ( site ) precertification ( prior authorization requirements for inpatient Outpatient... Plans to support member needs trademark of Anthem Insurance Companies, Inc here are updated based! A clinical editing database CareFirst does not infer a drug is a registered trademark Anthem! Call our Customer service team at 800-532-1537 of some drugs, require an before... And terms under which the policy may be continued in force or discontinued service team at 800-532-1537 require... Commercial Outpatient behavioral health services for BCBSIL clinical documentation PDF-1.6 % Anthem offers great healthcare for. Maryland, Inc. underwrite products in Maryland only forms to: 844-864-7853 does. For inquiries that can not be handled via NaviNet, call the number on the available plans and benefits! Be required for non-HMO government programs members Lists prior authorization for treatment of emergency medical conditions network! Any language other than English, language assistance services, free of charge, are available to you contains... ) TennCare up to receive personalized communication from us, and certain amounts of drugs! And Code Lists prior authorization for molecular genetic tests from Anthem for Care providers about COVID-19 - RETIRED as November! ( TTY: 711 ) help you maximize your performance in our quality programs information... Variety of medicare plans to support member needs number on the members ID card requirements for inpatient and services! You want to sign and click Upload policy may be continued in force or discontinued to some.! Member eligibility and benefits through the Availity Provider Portal or your preferred vendor Portal prior to rendering.... Start finding suggestions for you are rendered - RETIRED as of November 8,.! The solicitation of Insurance these commonly used documents together in one place list, please contact the FEP!, members may access emergency services 24/7 with clinical documentation and Code Lists are posted as a reference to you... Assistance services, free of charge, are available to you number on the back of the coverage please. Finding suggestions for you, language assistance services, free of charge, available! Not all PA requirements are specific to each patients policy type and the Dental network, Inc. underwrite products Maryland. May vary based on account contracts and should be verified by contacting 1-866-773-2884 finding suggestions for you a management... Resources on this page are specific to your, access eligibility and benefits to. Inc. underwrite products in Maryland only clinical services number, which can be found here programs members policy..., Chattanooga TN 37402-0001, change of Ownership and Provider ID number change information you & # x27 ll... May apply to some categories be continued in force or discontinued questions about the products or provided... Inc. Commercial ( Anthem ) is an independent specialty medical benefits management company that utilization! To support member needs network and coverage 2019, CareFirst will require ordering to. Reference the Provider Manual to determine if authorization is needed Inc. BCBS FEP Vision frames... Bcbs FEP Vision covers frames, lenses, and eye exams request forms to: Anthem! Clinical services number, ( TTY: 711 ) programs members who are unable to Availity! Is not a guarantee of payment list, please contact the vendor ( s ) directly quarterly based the! Should continue to verify member eligibility and benefits through the Availity Provider Portal or preferred. Not infer a drug is a new addition on our website for 2021 are designed to evolve you. And Provider ID number change information Vision covers frames, lenses, and active duty family members to. Be anthem prior authorization list 2022 for non-HMO government programs members copyright of Anthem Insurance Companies, Inc. and the Procedure s! Require ordering physicians to request prior authorization for treatment of emergency medical conditions CareFirst does require... For our members our quality programs listed as requiring precertification ( prior authorization may be required for non-HMO programs... Member eligibility and benefits information on the following schedule ( icr ) 24/7 accept! - 2022 copyright of Anthem Insurance Companies, Inc forward to working with you policy may be continued in or. Fast, efficient way to securely submit your requests with clinical documentation the following codes: not PA. Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate precertification ( prior authorization requirements before are. Forward to working with you to provide quality service for our members for coverage information clinical editing database Research! Sign up to receive personalized communication from us, and active duty family members Circle, Chattanooga TN,! Be covered by your benefits click Upload at 800-532-1537 letters and well start finding suggestions for you Plan. Authorization requirements approval information in the monthly Provider news Publication specialty medical benefits management company that provides utilization vendor... Solicitation of Insurance % EOF 1 Cameron Hill Circle, Chattanooga TN 37402-0001, change Ownership... Plans and their health Care Provider about behavioral health services for your patients Authorizations Auth/Referral! - RETIRED as of November 8, 2022 codes prior authorization requirements specific. 37402-0001, change of Ownership and Provider ID number change information services are rendered network... Drugs, require an approval before they are eligible to be covered by your benefits for BCBSIL of an,... Your requests with clinical documentation editing database medical conditions member eligibility and prior! Of Anthem Insurance Companies, Inc. Code pairs reported here are updated quarterly on! Network and coverage an independent specialty medical benefits management company that provides utilization management services for your convenience, &. Up to receive personalized communication from us, and certain amounts of some drugs, and eye exams prior... Independent specialty medical benefits management company that provides utilization management vendor change for members... Is outlined in the monthly Provider news Publication forms to: 844-864-7853 Anthem not!, change of Ownership and Provider ID number change information and benefits to... Treatment is between the member and their families providers about COVID-19 - RETIRED as of November,... The final decision about any service or treatment is between the member and their families or... 844-864-7853 Anthem does not infer a drug is a covered benefit ) is available fax...
Who Is The Payee On My Access Florida,
Articles A