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. o Massachusetts Collaborative Prior Authorization Form or o Blue Cross Blue Shield of Massachusetts Pre-certification Request Form Click on the title for complete list of drugs that require prior authorization: Medical Benefit Prior Authorization Medication List, #034 Medical Utilization Management and Pharmacy Prior Authorization, #033 Anthems PriorAuthorizationLookupToolOnlinecan assist with determining a codes prior authorization requirements. L3927 Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), without joint/spring, extension/flexion (for example, static or ring type), may include soft interface material, prefabricated, L5301 Below knee, molded socket, shin, SACH foot, endoskeletal system, L5321 Above knee, molded socket, open end, SACH foot, endoskeletal system, single axis knee, L5645 Addition to lower extremity, below knee (BK), flexible inner socket, external frame, L5649 Addition to lower extremity, ischial containment/narrow M-L socket, L3250 Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, each, 0232T Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed, 0397T Endoscopic retrograde cholangiopancreatography (ERCP), with optical endomicroscopy (List separately in addition to code for primary procedure. Prior approval for requested services - Arkansas Blue Cross Step 2 In Patient Information, provide the patients full name, phone number, full address, date of birth, sex (m/f), height, and weight. Prior Authorization Medication management With input from community physicians, specialty societies, and our Pharmacy & Therapeutics Committee, which includes community physicians and pharmacists from across the state, we design programs to help keep prescription drug coverage affordable. 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, | the content of any other website to which you may link, nor are ABCBS or the ABCBS Parties liable or responsible Use the Prior Authorization Lookup Tool within Availity or Call Provider Services at 1-855-661-2028. Submit a pharmacy pre-authorization through covermymeds.com or submit a claim with TransactRx. 2022 Electronic Forms LLC. ABCBS makes no warranties or representations of any kind, express or implied, nor Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Select Auth/Referral Inquiry or Authorizations. We're here to work with you, your doctor and the facility so you have the best possible health outcome. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), whichunderwrites or administersthe PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwritesor administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. color, national origin, age, disability, sex, gender identity, or sexual orientation. Prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com at anthem.com/medicareprovider > Login. Prior Authorization | BCBSMN - Blue Cross MN To learn more read Microsoft's help article. 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. Prior authorization lookup tool | NY Provider - Empire Blue Cross In some cases, we require more information and will request additional records so we can make a fully informed decision. In the case of an emergency, you do not need prior authorization. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). Deutsch | Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. The resources for our providers may differ between states. All rights reserved. This tool is for outpatient services only. Independent licensees of the Blue Cross and Blue Shield Association. 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. 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. In the case of a medical emergency, you do not need prior authorization to receive care. 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 Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. This website is owned and operated by USAble Mutual Insurance Company, d/b/a Arkansas Blue Cross and Blue Shield. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. Lastly, give the name of an office contact person along with the corresponding phone number, fax number, and email address. Prior authorization list | Blue Shield of CA Provider Prior-Authorization And Pre-Authorization | Anthem.com Step 8 In Medication / Medical and Dispensing Information, indicate the administration method and administration location. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid. | 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. They may request or review medical records, test results and other information so they understand what services are being performed and are able to make an informed decision. Prior Authorization | Blue Cross and Blue Shield of Illinois - BCBSIL ), 0421T Transurethral waterjet ablation of prostate, including control of post-operative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed), 0466T Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (List separately in addition to code for primary procedure. Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department The owners or operators of any other websites (not ABCBS) are solely responsible for the content and operation Prior authorization suspension for Anthem Ohio in-network hospital transfers to in-network skilled nursing facilities effective December 20, 2022 to January 15, 2023: Prior authorization suspension - In-network hospital transfers to In-network SNFs . 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. More prior authorization resources Sign in to Availity Tagalog | Submitting Prior Authorization | Provider | Premera Blue Cross Once you choose to link to another website, you understand and agree that you have exited this Please verify benefit coverage prior to rendering services. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual. To stay covered, Medicaid members will need to take action. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Find care, claims & more with our new app. 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. 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. In Connecticut: Anthem Health Plans, Inc. Non-individual members Use Availity to submit prior authorizations and check codes. Important: Blueprint Portal will not load if you are using Internet Explorer. Anthem does not require prior authorization for treatment of emergency medical conditions. We look forward to working with you to provide quality services to our members. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. Prior authorization helps address the issue of rising healthcare costs by keeping procedures and services that are not medically necessary from being performed. | Contracted and non-contracted providers who are unable to access Availity* may call the number on the back of the member's ID card. In the event of an emergency, members may access emergency services 24/7. Register today for the Advancing Mental Health Equity for Youth & Young Adults forum hosted by Anthem Blue Cross and Blue Shield (Anthem) and Motivo* for Anthem providers on March 15, 2023. View requirements for Basic Option, Standard Option and FEP Blue Focus. 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. Prior Authorization Information | Blue Cross of Idaho - bcidaho.com Availity is solely responsible for its products and services. Copyright 2001-2023 Arkansas Blue Cross and Blue Shield. 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. 1 Services may be listed as requiring prior authorization that may not be covered benefits for a particular member. Do you offer telehealth services? of merchantability or fitness for a particular purpose, nor of non-infringement, with regard to the content 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. Out-of-area providers Prior Authorization Contact Information Providers and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal) Phone: 1-888-831-2246 Hours: Monday to Friday, 8 a.m. to 5 p.m. Fax: 1-800-754-4708 Use these lists to identify the member services that require prior authorization. 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. Prior Authorization Requirements - Blue Cross MN By filling out the form completely and with as much information as possible, you can be sure we have the information to process your request timely. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Use of the Anthem websites constitutes your agreement with our Terms of Use. We look forward to working with you to provide quality services to our members. Expand All In Indiana: Anthem Insurance Companies, Inc. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. March 2023 Anthem Provider News - New Hampshire, February 2023 Provider Newsletter - New Hampshire, Telephonic-only care allowance extended through April 11, 2023 - New Hampshire, January 2023 Provider Newsletter - New Hampshire, Reimbursement for services by clinical behavioral health providers seeking licensure, Time to prepare for HEDIS medical record review, New policy for EMR clinical data sharing and ADT notifications, Reimbursement policy update: Modifiers 25 and 57 - Professional, Specialty pharmacy updates for March 2023, Clinical Criteria updates for specialty pharmacy. In Indiana: Anthem Insurance Companies, Inc. Use of the Anthem websites constitutes your agreement with our Terms of Use. Authorizations | Providers | Excellus BlueCross BlueShield Anthem (Blue Cross Blue Shield) Prior (Rx) Authorization Form If your state isn't listed, check out bcbs.com to find coverage in your area. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the members Medical Policy and Prior Authorization for Blue Plans. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. In Indiana: Anthem Insurance Companies, Inc. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. | You are about to leave regence.com and enter another website that is not affiliated with or licensed by the Blue Cross Blue Shield Association. Some procedures may also receive instant approval. Blueprint Portal is a members-only website that will help you understand and manage your health plan so youre able to find quality, patient-focused healthcare at the best possible price. Other Blue Plans pre-authorization requirements may differ from ours. View the FEP-specific code list and forms. Call Provider Services at 1-800-450-8753 (TTY 711) After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-300-8181 To request authorizations: From the Availity home page, select Patient Registration from the top navigation. 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. Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. The resources for our providers may differ between states. 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. benefit certificate to determine which services need prior approval. 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.

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