An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. In the case of a medical emergency, you do not need prior authorization to receive care. The CarelonRx member services telephone number is 833-279-0458. 2022 Electronic Forms LLC. You are invited: Advancing Mental Health Equity for Youth & Young Adults. In Indiana: Anthem Insurance Companies, Inc. View requirements for Basic Option, Standard Option and FEP Blue Focus. | The best way to ensure you're submitting everything needed for a prior authorization is to use the prior authorization/precertification form at anthem.com/medicareprovider > Providers > Provider Resources > Forms and Guides. Sign in to the appropriate website to complete your request. In Kentucky: Anthem Health Plans of Kentucky, Inc. We currently don't offer resources in your area, but you can select an option below to see information for that state. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. Inpatient services and nonparticipating providers always require prior authorization. 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. 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. 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. Expand All State & Federal / Medicare. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Phone - Call the AIM Contact Center at 866-455-8415, Monday through Friday, 6 a.m. to 6 p.m., CT; and 9 a.m. to noon, CT on weekends and holidays. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Italiano | In Kentucky: Anthem Health Plans of Kentucky, Inc. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for Sep 1, 2021 In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Anthem partners with health care professionals to close gaps in care and improve members overall heath. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). | . 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. 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. Use Availity to submit prior authorizations and check codes. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Select Auth/Referral Inquiry or Authorizations. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. Espaol | In the event of an emergency, members may access emergency services 24/7. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Administrative. of all such websites. nor state or imply that you should access such website or any services, products or information which You can find the number on the back of your ID card, or you can write to us at the following address: Appeals and Grievance CoordinatorBlue Cross of IdahoPO Box 7408Boise, ID 83707. Step 10 On page 2 (1), select yes or no to indicate whether the patient has tried other medications for their condition. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Independent licensees of the Blue Cross and Blue Shield Association. This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. You can also refer to the provider manual for information about services that require prior authorization. Electronic authorizations. If you receive services that are not medically necessary from one of Blue Cross of Idahos contracting providers without getting prior authorization and payment for the services is denied, you are not financially responsible. 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. 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. With prior authorization, Blue Cross of Idaho is able to: Prior authorization is just one of the ways we're working to save our members money and address rising healthcare costs. 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, Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). Review requirements for Medicare Advantage members. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Prior to surgical treatment of gender dysphoria in FEP members, you must submit a treatment plan, including all surgeries planned, and the estimated date each will be performed. The form contains important information regarding the patient's medical history and requested medication which Anthem will use to determine whether or not the prescription is included in the patient's health care plan. In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. It looks like you're in . 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. FEP Basic Option/Standard OptionFEP Blue Focus. Information about COVID-19 and your insurance coverage. Easily obtain pre-authorization and eligibility information with our tools. In Indiana: Anthem Insurance Companies, Inc. | color, national origin, age, disability, sex, gender identity, or sexual orientation. Use of the Anthem websites constitutes your agreement with our Terms of Use. | Independent licensees of the Blue Cross Association. Posted Jan. 11, 2021. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Anthem is a registered trademark of Anthem Insurance Companies, Inc. This tool is for outpatient services only. Use the search tool to find the Care Center closest to you. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Therefore, its important for you to know your benefits and covered services. 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. Learn more about electronic authorization. Our electronic prior authorization (ePA) process is the preferred method for . This helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. In Maine: Anthem Health Plans of Maine, Inc. website. 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. We also want to ensure you receive the right technology that addresses your particular clinical issue. FEP utilizes Magellan Rx Management for medical, Providers requesting prior approval for an ASE/PSE member should use the appropriate form on the, Providers who are requesting a prior approval for Walmart or other BlueAdvantage members should use the appropriate form from the, Providers who are requesting a prior approval for BlueMedicare or Health Advantage Medicare Advantage members should use the appropriate form from, Providers requesting prior approval for Part B drugs for BlueMedicare or Health Advantage Medicare should use the, Name and telephone number of contact person, Requesting / Performing Providers NPI or Provider ID, Copy of members insurance card (front/back), CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable, Please use the most descriptive procedure and diagnosis codes, Medical records to support requested services. URAC Accredited - Health Plan with Health Insurance Marketplace (HIM) - 7.3, URAC Accredited - Health Utilization Management - 7.4, Member forms - Individual and family plans, Coverage policy and pre-certification/pre-authorization, Approval information for radiological services, Medicare Advantage Prior Authorization Request Form, Part B Medication Prior Approval Request Form, Check deductible and out-of-pocket totals. 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. All rights reserved. Prior authorization to confirm medical necessity is required for certain services and benefit plans as part of our commitment to help ensure all Blue Cross and Blue Shield of Illinois (BCBSIL) members get the right care, at the right time, in the right setting. In Maine: Anthem Health Plans of Maine, Inc. Type at least three letters and well start finding suggestions for you. Updated June 02, 2022. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . In the case of an emergency, you do not need prior authorization. under any circumstances for the activities, omissions or conduct of any owner or operator of any other This may result in a delay of our determination response. 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. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. State & Federal / Medicare. Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). If yes, provide the medication name, dosage, duration of therapy, and outcome. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Kreyl Ayisyen | Ting Vit | 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. 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 look forward to working with you to provide quality services to our members. Typically, we complete this review within two business days, and notify you and your provider of our decision. L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, L3925 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), non-torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf. This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. Find a Care Center. website and are no longer accessing or using any ABCBS Data. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada.