Reimbursement Policies. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). The resources for our providers may differ between states. You can also visit bcbs.com to find resources for other states. Access eligibility and benefits information on the Availity* Portal OR. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. 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. This may include but is not limited to decisions involving pre-certification, inpatient review, level of care, discharge planning and retrospective review. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. 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. The resources on this page are specific to your state. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. In Ohio: Community Insurance Company. Please verify benefit coverage prior to rendering services. The tool will tell you if that service needs . If youre concerned about losing coverage, we can connect you to the right options for you and your family. Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2023. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. Precertification Lookup Tool -- easy access to prior - Anthem Payments for services from a non-participating provider are generally sent to the member, except where federal or state mandates apply, or negotiated agreements are in place. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. Our resources vary by state. We currently don't offer resources in your area, but you can select an option below to see information for that state. Anthem is a registered trademark of Anthem Insurance Companies, Inc. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Make your mental health a priority. You can also visit bcbs.com to find resources for other states. Find answers to all your questions with an Anthem representative in real time. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. Medicaid renewals will start again soon. Understand your care options ahead of time so you can save time and money. Inpatient services and non-participating providers always require prior authorization. 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.) Sydney Care is offered through an arrangement with Carelon Digital Platforms, Inc. Sydney Health and Sydney Care are service marks of Carelon Digital Platforms, Inc., 2023. Choose your location to get started. Vaccination is important in fighting against infectious diseases. The medical policies generally apply to all of the Plans fully-insured benefits plans, although some local variations may exist. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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. Prior authorization lookup tool | Georgia Provider - Amerigroup Type a Current Procedural Terminology, or CPT, code or a Healthcare Common Procedure Coding System, or HCPCS, code in the space below to get started. 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. 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. Providers | Tools, Resources & More | Anthem.com This tool is for outpatient services only. We update the Code List to conform to the most recent publications of CPT and HCPCS . We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. If your state isn't listed, check out bcbs.com to find coverage in your area. To get started, select the state you live in. Inpatient services and non-participating providers always require prior authorization. Your dashboard may experience future loading problems if not resolved. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. In Kentucky: Anthem Health Plans of Kentucky, Inc. Inpatient services and nonparticipating providers always require prior authorization. In Maine: Anthem Health Plans of Maine, Inc. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Members should discuss the information in the medical policies with their treating health care professionals. 711. Jan 1, 2020 This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Prior-Authorization And Pre-Authorization | Anthem.com Our resources vary by state. Enter a CPT or HCPCS code in the space below. There are several factors that impact whether a service or procedure is covered under a members benefit plan. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Type at least three letters and we will start finding suggestions for you. Your browser is not supported. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Youll also strengthen your appeals with access to quarterly versions since 2011. Be sure name and NPI entered for ordering provider belongs to a physician or non-physician practitioner. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. It looks like you're in . Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. Call our Customer Service number, (TTY: 711). As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. Reason Code 16 | Remark Codes MA13 N265 N276 - JA DME As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. ET Register Here Become an Availity user today If you aren't registered to use Availity, signing up is easy and 100% secure. Provider Policies, Guidelines and Manuals | Anthem.com Apr 1, 2022 Procedure Code Lookup Tool - Washington State Local Health Insurance Provider Medical Policies | Anthem.com Find information that's tailored for you. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Select Auth/Referral Inquiry or Authorizations. Start a Live Chat with one of our knowledgeable representatives. 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. Inpatient services and non-participating providers always require prior authorization. There is no cost for our providers to register or to use any of the digital applications. 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. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. Quickly and easily submit out-of-network claims online. We currently don't offer resources in your area, but you can select an option below to see information for that state. Reaching out to Anthem at least here on our. Choose your state below so that we can provide you with the most relevant information. 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. Health equity means that everyone has the chance to be their healthiest. The notices state an overpayment exists and Anthem is requesting a refund. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans You can also visit. 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. Use the Prior Authorization tool within Availity. It may not display this or other websites correctly. We currently don't offer resources in your area, but you can select an option below to see information for that state. For costs and complete details of the coverage, please contact your agent or the health plan. Precertification lookup tool | Anthem We currently don't offer resources in your area, but you can select an option below to see information for that state. We look forward to working with you to provide quality service for our members. Members should contact their local customer service representative for specific coverage information. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. We look forward to working with you to provide quality services to our members. Were committed to supporting you in providing quality care and services to the members in our network. Select Your State Once youve accessed the Precertification Lookup Tool, choose a line of business from the menu selection offered, and then type the CPT/HCPCS code or a code description to determine if a prior authorization is required. Question Anthem Commercial Policy of Wisconsin Consultation Codes - AAPC Choose your location to get started. 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.