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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Prior Authorization Code Lookup Find out if prior authorization from Highmark Health Options is required for medical procedures and services. Enter a Current Procedural Terminology (CPT) code in the space below to get started. For subsequent inpatient care, see 99231-99233. Access your member ID card from our website or mobile app. 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. Were committed to supporting you in providing quality care and services to the members in our network. Medicaid renewals will start again soon. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Anthem is a registered trademark of Anthem Insurance Companies, Inc. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. The COVID19 pandemic and nationwide shutdown that started in March 2020 placed a spotlight on crisis preparedness within the U.S. hea Dont assume the codes youve been using to report drugs and biologicals still apply. Use of the Anthem websites constitutes your agreement with our Terms of Use. Additional medical policies may be developed from time to time and some may be withdrawn from use. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. The resources for our providers may differ between states. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plans medical policy. Access eligibility and benefits information on the Availity* Portal OR. * Services may be listed as requiring precertification that may not be covered benefits for a particular member. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. You can access the Precertification Lookup Tool through the Availity Portal. Choose your state below so that we can provide you with the most relevant information. Search by keyword or procedure code for related policy information. Your browser is not supported. March 2023 Anthem Provider News - Missouri, 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, April 2022 Anthem Provider News - Missouri, enable member benefit lookup by CPT and HCPC procedure codes, Enter up to eight procedure codes per transaction, provide additional cost share information by place of service, return Is Authorization Required? information, include additional plan-level benefit limitations. These guidelines do not constitute medical advice or medical care. Your online account is a powerful tool for managing every aspect of your health insurance plan. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Our call to Anthem resulted in a general statement basically use a different code. Anthem is a registered trademark of Anthem Insurance Companies, 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. Not connected with or endorsed by the U.S. Government or the federal Medicare program. It looks like you're in . 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.) We look forward to working with you to provide quality service for our members. 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. The medical policies do not constitute medical advice or medical care. To stay covered, Medicaid members will need to take action. We look forward to working with you to provide quality service for our members. Future updates regarding COVID-19 will appear in the monthly Provider News publication. Medicare Complaints, Grievances & Appeals. Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc., independent licensee of the Blue Cross and Blue Shield Association. The resources for our providers may differ between states. Where is the Precertification Lookup Tool located on Availity? There is no cost for our providers to register or to use any of the digital applications. Choose your location to get started. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. Prior authorization lookup tool Please verify benefit coverage prior to rendering services. You can also visit bcbs.com to find resources for other states. If your state isn't listed, check out bcbs.com to find coverage in your area. Our resources vary by state. You can also visit, AIM PT/OT/ST Authorization Important Notice, Anthem taps Paul Marchetti to lead companys overall care transformation strategy, Medicare Supplement claim error expected to be resolved by March 31, Medicare Supplement members to receive new ID cards; claims handling for crossover, Medicare Supplement Member ID Card Change Postponed. Members should discuss the information in the medical policies with their treating health care professionals. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Make your mental health a priority. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Apr 1, 2022 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. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. New member? For a better experience, please enable JavaScript in your browser before proceeding. Large Group You can also visit bcbs.com to find resources for other states. State & Federal / Medicaid. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. We currently don't offer resources in your area, but you can select an option below to see information for that state. Members should discuss the information in the clinical UM guideline with their treating health care providers. Choose your location to get started. 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. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. In Indiana: Anthem Insurance Companies, Inc. The resources on this page are specific to your state. If your state isn't listed, check out bcbs.com to find coverage in your area. Our resources vary by state. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. If you arent registered to use Availity, signing up is easy and 100% secure. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Choose your state below so that we can provide you with the most relevant information. Use the Prior Authorization tool within Availity OR. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. We have developed clinical UM guidelines that serve as one of the sets of guidelines for coverage decisions. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Please verify benefit coverage prior to rendering services. Call our Customer Service number, (TTY: 711). Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. 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. The resources for our providers may differ between states. 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. Select Auth/Referral Inquiry or Authorizations. Choose your location 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. Independent licensees of the Blue Cross and Blue Shield Association. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Access resources to help health care professionals do what they do bestcare for our members. Understand your care options ahead of time so you can save time and money. This tool is for outpatient services only. You are using an out of date browser. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more.
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