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. 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Contact 866-773-2884 for authorization regarding treatment. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. PPO outpatient services do not require Pre-Service Review. Please verify benefit coverage prior to rendering services. Oct 1, 2020 Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital . 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. As healthcare costs go up, health insurance premiums also go up to pay for the services provided. 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 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Do not sell or share my personal information. Our team of licensed physicians, registered nurses, or pharmacy technicians receive and review all prior authorization requests. Non-individual members Use Availity to submit prior authorizations and check codes. View requirements for Basic Option, Standard Option and FEP Blue Focus. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Step 1 At the top of the form, supply the plan/medical group name, plan/medical group phone number, and plan/medical group fax number. To learn more read Microsoft's help article. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. 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. Our resources vary by state. In Connecticut: Anthem Health Plans, Inc. Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. 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. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. 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. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. 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. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Review requirements for Medicare Advantage members. In some cases, we require more information and will request additional records so we can make a fully informed decision. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. View requirements for group and Individual members on our commercial products. In Connecticut: Anthem Health Plans, Inc. of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. | State & Federal / Medicare. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Please verify benefit coverage prior to rendering services. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Online - The AIM ProviderPortal is available 24x7. The Blue Cross name and symbol are registered marks of the Blue Cross Association. 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. Prior Authorization details for providers outside of WA/AK. No, the need for emergency services does not require prior authorization. It looks like you're outside the United States. The team reviews the requested service(s), determines if it is medically necessary and if the service is covered under your insurance plan. In Maine: Anthem Health Plans of Maine, Inc. color, national origin, age, disability, sex, gender identity, or sexual orientation. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. nor state or imply that you should access such website or any services, products or information which It looks like you're in . Obtaining a prior authorization from Blue Cross of Idaho prevents this frustration. 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. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. For both outpatient procedures and treatment requiring an inpatient stay, call (800) 633-4581 to obtain prior authorization. Expand All We currently don't offer resources in your area, but you can select an option below to see information for that state. others in any way for your decision to link to such other websites. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members Deutsch | We want you to receive the best care at the right time and place. Anthem is a registered trademark of Anthem Insurance Companies, Inc. the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). 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. In Connecticut: Anthem Health Plans, Inc. Step 9 At the top of page 2, provide the patients name and ID number. There is a list of these services in your member contract. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. | Other Blue Plans pre-authorization requirements may differ from ours. Step 7 In Medication / Medical and Dispensing Information, specify the following prescription details: dose/strength, frequency, length of therapy/number of refills, and quantity. Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. We look forward to working with you to provide quality services to our members. Out-of-area providers 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. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. Inpatient services and nonparticipating providers always require prior authorization. In Kentucky: Anthem Health Plans of Kentucky, Inc. 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. Use Availity's electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. In Indiana: Anthem Insurance Companies, Inc. 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. Independent licensees of the Blue Cross and Blue Shield Association. Oromoo | In Indiana: Anthem Insurance Companies, Inc.

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