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Our resources vary by state. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Choose your location to get started. A group NPI cannot be used as ordering NPI on a Medicare claim. 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. To stay covered, Medicaid members will need to take action. Medical technology is constantly evolving and these medical policies are subject to change without notice, although we will use good faith efforts to provide advance notice of changes that could have a negative impact on benefits. We offer flexible group insurance plans for any size business. The notices state an overpayment exists and Anthem is requesting a refund. Use the Prior Authorization tool within Availity. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. This page outlines the basis for reimbursement if the service is covered by an Anthem member's benefit plan. The Blue Cross name and symbol are registered marks of the Blue Cross Association. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Click Submit. We currently don't offer resources in your area, but you can select an option below to see information for that state. Directions. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) has an online tool that displays prior authorization guidelines to help you quickly determine whether certain services for Anthem members require a prior authorization. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. JavaScript is disabled. If a prior authorization (PA) is required (indicates "yes" or "no") If there are PA conditions; If the service is a covered benefit (indicates "covered" or "not covered") In Kentucky: Anthem Health Plans of Kentucky, Inc. Apr 1, 2022 Please update your browser if the service fails to run our website. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. In Maine: Anthem Health Plans of Maine, Inc. 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 that may not be covered benefits for a particular member. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Explore our resources. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. Reimbursement Policies. Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). The resources on this page are specific to your state. If this is your first visit, be sure to check out the. You can also visit bcbs.com to find resources for other states. Medicare Complaints, Grievances & Appeals. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. Vaccination is important in fighting against infectious diseases. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. 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. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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. Start by logging onto Availity.com and selecting the Register icon at the top of the home screen or use this link to access the registration page. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. These documents are available to you as a reference when interpreting claim decisions. Access to the information does not require an Availity role assignment, tax ID or NPI. Please note that services listed as requiring precertification may not be covered benefits for a member. Contact will be made by an insurance agent or insurance company. 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.) Plus, you may qualify for financial help to lower your health coverage costs. We currently don't offer resources in your area, but you can select an option below to see information for that state. If your state isn't listed, check out bcbs.com to find coverage in your area. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. It looks like you're outside the United States. For discharge from an inpatient stay on a different date of service than the admission, see 99238-99239. 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. Clinical UM guidelines can be highly technical and complex and are provided here for informational purposes. Choose your location to get started. February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. We currently don't offer resources in your area, but you can select an option below to see information for that state. The resources on this page are specific to your state. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. In Kentucky: Anthem Health Plans of Kentucky, Inc. Find drug lists, pharmacy program information, and provider resources. Jan 1, 2020 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. Inpatient services and nonparticipating providers always require prior authorization. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Please verify benefit coverage prior to rendering services. 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. Select Your State refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. In Connecticut: Anthem Health Plans, Inc. Prior Authorization Lookup. Please Select Your State The resources on this page are specific to your state. Administrative / Digital Tools, Learn more by attending this live webinar. Start a Live Chat with one of our knowledgeable representatives. You can also visit bcbs.com to find resources for other states. 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. Please verify benefit coverage prior to rendering services. It may not display this or other websites correctly. ET. Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. Understand your care options ahead of time so you can save time and money. 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. Access resources to help health care professionals do what they do bestcare for our members. Out-of-state providers. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Medicaid renewals will start again soon. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Join us for a live webinar demonstration and learn how these enhancements will improve member information return. Our resources vary by state. In Connecticut: Anthem Health Plans, Inc. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. 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. State & Federal / Medicaid. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Our resources vary by state. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Interested in joining our provider network? Lets make healthy happen. With Codify by AAPC cross-reference tools, you can check common code pairings. We currently don't offer resources in your area, but you can select an option below to see information for that state. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. Medical policy does not constitute plan authorization, nor is it an explanation of benefits.