anthem blue cross prior authorization list

Prior approval for requested services - Arkansas Blue Cross and Blue Shield Prior approval for requested services The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. You can also refer to the provider manual for information about services that require prior authorization. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Register today for the Advancing Mental Health Equity for Youth & Young Adults forum hosted by Anthem Blue Cross and Blue Shield (Anthem) and Motivo* for Anthem providers on March 15, 2023. 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. Sign in to the appropriate website to complete your request. Anthem Blue Cross Blue Shield: Health Insurance, Medicare & More Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. If your state isn't listed, check out bcbs.com to find coverage in your area. In the event of an emergency, members may access emergency services 24/7. Other Blue Plans pre-authorization requirements may differ from ours. Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. State & Federal / Medicare. Prior Authorization Information | Blue Cross of Idaho - bcidaho.com We currently don't offer resources in your area, but you can select an option below to see information for that state. Step 6 In Medication / Medical and Dispensing Information, describe how the patient paid fortheir medication (include the insurance name and prior authorization number). Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. PPO outpatient services do not require Pre-Service Review. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. March 2023 Anthem Provider News - Georgia, February 2023 Anthem Provider News - Georgia, New ID cards for Anthem Blue Cross and Blue Shield members - Georgia, Telephonic-only care allowance extended through April 11, 2023 - Georgia, January 2023 Anthem Provider News - Georgia, prior authorization/precertification form, September 2021 Anthem Provider News - Georgia. Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation View requirements for group and Individual members on our commercial products. Visit Anthem.com to learn more about how we coordinate our medical and pharmacy benefits, review our drug lists, submit prior authorization requests, and more. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Use of the Anthem websites constitutes your agreement with our Terms of Use. Ting Vit | Prior-Authorization And Pre-Authorization | Anthem.com To stay covered, Medicaid members will need to take action. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. Federal Employee Program. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. Step 4 In Prescriber Information, specifythe prescribers full name, speciality, and full address. Espaol | 2022 Electronic Forms LLC. We deliver personalized healthcare the way you want it, where you need it: in our neighborhood Care Centers, in your own home, in hospitals or skilled nursing facilities. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). 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. federal and Washington state civil rights laws. If you choose to access other websites from this website, you agree, as a condition of choosing any such Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Prior Authorization Requirements - Blue Cross MN | Premera Blue Cross complies with applicable federal and Washington state civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, gender identity, Online - The AIM ProviderPortal is available 24x7. Administrative. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. Type at least three letters and well start finding suggestions for you. In Connecticut: Anthem Health Plans, Inc. Our resources vary by state. In Indiana: Anthem Insurance Companies, Inc. Prior Authorization | BCBSMN - Blue Cross MN Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. March 2023 Anthem Provider News - New Hampshire, February 2023 Provider Newsletter - New Hampshire, Telephonic-only care allowance extended through April 11, 2023 - New Hampshire, January 2023 Provider Newsletter - New Hampshire, Reimbursement for services by clinical behavioral health providers seeking licensure, Time to prepare for HEDIS medical record review, New policy for EMR clinical data sharing and ADT notifications, Reimbursement policy update: Modifiers 25 and 57 - Professional, Specialty pharmacy updates for March 2023, Clinical Criteria updates for specialty pharmacy. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. We currently don't offer resources in your area, but you can select an option below to see information for that state. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services. You further agree that ABCBS and its others in any way for your decision to link to such other websites. It looks like you're outside the United States. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. You can access the Precertification Lookup Tool through the Availity Portal. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. o Massachusetts Collaborative Prior Authorization Form or o Blue Cross Blue Shield of Massachusetts Pre-certification Request Form Click on the title for complete list of drugs that require prior authorization: Medical Benefit Prior Authorization Medication List, #034 Medical Utilization Management and Pharmacy Prior Authorization, #033 We're here to work with you, your doctor and the facility so you have the best possible health outcome. Easily obtain pre-authorization and eligibility information with our tools. Independent licensees of the Blue Cross Association. Information about COVID-19 and your insurance coverage. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. The CarelonRx member services telephone number is 833-279-0458. Prior Authorization Requirement Summaries, Code Lists and - BCBSIL Carelon Medical Benefits Management, Inc. You are invited: Advancing Mental Health Equity for Youth & Young Adults, Reminder: Updated Carelon Medical Benefits Management, Inc. Musculoskeletal Program effective April 1, 2023 - Site of care reviews, Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update, Provider directory - annual audit for NCQA Accreditation, Statin Therapy Exclusions for Patients With Cardiovascular Disease/Diabetes HEDIS measures, March is National Colorectal Cancer Awareness Month, Reminder - Updated Carelon Musculoskeletal Program effective April 1, 2023: monitored anesthesia care reviews, Consumer payment option, Pay Doctor Bill, to terminate effective March 31, 2023, Pharmacy information available on our provider website, Controlling High Blood Pressure and Submitting Compliant Readings, Shared savings and transition care management after inpatient discharges. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Use Availitys electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. You can also visit, Standard Local Prior Authorization Code List, Standard Prior Authorization Requirements, SHBP Precertification Procedure Codes Sheet, SHBP Co-pay/Co-insurance Waiver Medication List. Your plan has a list of services that require prior authorization. PDF Authorization requirements by product - Blue Cross Blue Shield of ), 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation, 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach, 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach, 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach, 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy), 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis, 33419 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure), 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed, 33979 Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle, 33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only, 36514 Therapeutic Apheresis; Plasma Pheresis, 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection, 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed, A4224 Supplies for maintenance of insulin infusion catheter, per week, A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each, A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe, A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fah, A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each, A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries, C1722 Cardioverter-defibrillator, single chamber (implantable), L5671 Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert, L5673 Addition to lower extremity, below knee/above knee, custom fabricated, L5679 Addition to lower extremity, below knee/above knee, custom fabricated, L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature, L5981 All lower extremity prostheses, flex-walk system or equal, L5987 All lower extremity prostheses, shank foot system with vertical loading pylon, L8699 Prosthetic implant, not otherwise specified, L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code.

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