Access your member ID card from our website or mobile app. 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. Contact will be made by an insurance agent or insurance company. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 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. We look forward to working with you to provide quality service for our members. Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. It looks like you're outside the United States. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Enter a CPT or HCPCS code in the space below. Additional clinical UM guidelines may be developed from time to time and some may be withdrawn from use. They are not agents or employees of the Plan. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. Available for iOS and Android devices. Please update your browser if the service fails to run our website. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 711. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Our resources vary by state. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manualand support for delivering benefits to our members. Start a Live Chat with one of our knowledgeable representatives. Medical policies and clinical utilization management (UM) guidelines are two resources that help us determine if a procedure is medically necessary. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Please Select Your State The resources on this page are specific to your state. Youll also strengthen your appeals with access to quarterly versions since 2011. Search by keyword or procedure code for related policy information. Your dashboard may experience future loading problems if not resolved. As the nation's second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Or You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. In Ohio: Community Insurance Company. For patients admitted and discharged from observation or inpatient status on the same date, see 99234-99236. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. Anthem is a registered trademark of Anthem Insurance Companies, Inc. It looks like you're outside the United States. There is no cost for our providers to register or to use any of the digital applications. 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. Independent licensees of the Blue Cross Association. 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. 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. We offer affordable health, dental, and vision coverage to fit your budget. 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") Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. Find a Medicare plan that fits your healthcare needs and your budget. It looks like you're outside the United States. In Ohio: Community Insurance Company. JavaScript is disabled. Please note: This tool is for outpatient services only. 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. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Where is the Precertification Lookup Tool located on Availity? 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. It looks like you're in . Type at least three letters and we will start finding suggestions for you. It may not display this or other websites correctly. Its proven that a diagnosis of heart disease or ex Healthcare business professionals from around the world came together at REVCON a virtual conference by AAPC Feb. 78 to learn how to optimize their healthcare revenue cycle from experts in the field. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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. 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. Find drug lists, pharmacy program information, and provider resources. You can also type part of the code's description to search, for example type "tonsil" to find "Removal of tonsils." This tool can be used to check if a prior authorization is required for health care services covered by Blue Cross and Blue Shield of Minnesota commercial health plans, Medicare Advantage and Platinum Blue. It looks like you're in . We currently don't offer resources in your area, but you can select an option below to see information for that state. We currently don't offer resources in your area, but you can select an option below to see information for that state. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). It does not reflect benefits coverage, nor does it include an exhaustive listing of all non-covered services (in other words, experimental procedures, cosmetic surgery, etc.). We look forward to working with you to provide quality services to our members. 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. In Maine: Anthem Health Plans of Maine, Inc. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. The Precertification Lookup Tool will let you know if clinical edits apply, information such as the medical necessity criteria used in making the authorization decision, and if a vendor is used -- without the need to make a phone call. You can also visit. Choose your state below so that we can provide you with the most relevant information. Select Auth/Referral Inquiry or Authorizations. This tool is for outpatient services only. Access to the information does not require an Availity role assignment, tax ID or NPI. Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. For costs and complete details of the coverage, please contact your agent or the health plan. 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. The resources on this page are specific to your state. If you would like to request a hard copy of an individual medical policy, please contact the member's health plan at the number on the back of their identification card. It looks like you're in . Type at least three letters and well start finding suggestions for you. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. You can also visit bcbs.com to find resources for other states. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. We look forward to working with you to provide quality service for our members. 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 this is your first visit, be sure to check out the. Make your mental health a priority. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. ) refer to your, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity or. Price a medication, find a pharmacy,order auto refills, and more. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Explore our resources. We currently don't offer resources in your area, but you can select an option below to see information for that state. Screening, Brief Intervention, and Referral to Treatment, Early and Periodic Screening, Diagnostic and Treatment, Indiana Medicaid Prior Authorization Requirements List, New Option Available for Indiana Market. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility.