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Future updates regarding COVID-19 will appear in the monthly Provider News publication. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. We look forward to working with you to provide quality services to our members. You are using an out of date browser. We look forward to working with you to provide quality service for our members. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. These learning opportunities will assist you in administering your patients health plan and provide you with the knowledge to best assist our members. Do not sell or share my personal information. Find a Medicare plan that fits your healthcare needs and your budget. 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. 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. Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. After hours, verify member eligibility by calling the 24/7 NurseLine at. 711. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. In Indiana: Anthem Insurance Companies, Inc. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. State & Federal / Medicaid. With Codify by AAPC cross-reference tools, you can check common code pairings. You can also visit bcbs.com to find resources for other states. 2005 - 2023 copyright of Anthem Insurance Companies, Inc. Please verify benefit coverage prior to rendering services. We also have the right to customize MCG guidelines based on determinations by the Medical Policy & Technology Assessment Committee (MPTAC). We offer affordable health, dental, and vision coverage to fit your budget. American Hospital Association ("AHA"), Jury Convicts Physician for Misappropriating $250K From COVID-19 Relief, REVCON Wrap-up: Mastering the Revenue Cycle, OIG Audit Prompts ASPR to Improve Its Oversight of HPP, Check Out All the New Codes for Reporting Services and Supplies to Medicare, Keyword database enhanced with medical acronyms and terminology, Default settings to lock in your preference for code-centered or range pages, Code Constructor to narrow down your code options one clickable range at a time, Lay terms and CPT code update information, An expanded index by service eases looking for a procedure or service. If youre concerned about losing coverage, we can connect you to the right options for you and your family. We want to help physicians, facilities and other health care professionals submit claims accurately. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Were committed to supporting you in providing quality care and services to the members in our network. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Plus, you may qualify for financial help to lower your health coverage costs. With features like these, its no surprise: Conviction is just one of more than 130 such criminal cases involving 80 million A federal jury convicted a Colorado physician Jan. 13 for misappropriating about 250000 from two separate COVID19 relie Can depression increase the risk of heart disease In recent years scientists have attempted to establish a link between depression and heart disease. Your dashboard may experience future loading problems if not resolved. 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. Administrative / Digital Tools, Learn more by attending this live webinar. In Connecticut: Anthem Health Plans, Inc. If you arent registered to use Availity, signing up is easy and 100% secure. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Enter a Current Procedural Terminology (CPT) code in the space below to get started. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. If your state isn't listed, check out bcbs.com to find coverage in your area. If your state isn't listed, check out bcbs.com to find coverage in your area. Type at least three letters and well start finding suggestions for you. Medical technology is constantly evolving and clinical UM guidelines are subject to change without notice. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. Prior authorization lookup tool| HealthKeepers, Inc. 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. out of your benefits, find the best healthcare, and stay healthy. Select a State Policies & Guidelines Medical Policies & Clinical UM Guidelines There are several factors that impact whether a service or procedure is covered under a member's benefit plan. All other available Medical Policy documents are published by policy/topic title. The clinical UM guidelines published on this web site represent the clinical UM guidelines currently available to all health plans throughout our enterprise. Providers: Select Hoosier Care Connect in the Line of Business field whenever applicable. 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. You must log in or register to reply here. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. 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") Our resources vary by state. 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.). You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks. 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. Inpatient services and nonparticipating providers always require prior authorization. It may not display this or other websites correctly. Your browser is not supported. We look forward to working with you to provide quality services to our members. 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. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. JavaScript is disabled. Please verify benefit coverage prior to rendering services. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc. Here you'll find information on the available plans and their benefits. We look forward to working with you to provide quality service for our members. Please update your browser if the service fails to run our website. registered for member area and forum access, https://www11.anthem.com/provider/noapplication/f0/s0/t0/pw_g280336.pdf?refer=ahpmedprovider&state=mo. It looks like you're outside the United States. Most Recently our office has been sent several recoupment notification from Anthem Blue Cross Blue Shield. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. 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. Additional medical policies may be developed from time to time and some may be withdrawn from use. This tool is for outpatient services only. We currently don't offer resources in your area, but you can select an option below to see information for that state. February 2023 Anthem Provider News - Nevada, New ID cards for Anthem Blue Cross and Blue Shield members - Nevada, Telephonic-only care allowance extended through April 11, 2023 - Nevada, January 2020 Anthem Provider News and Important Updates - Nevada. The resources for our providers may differ between states. Members should discuss the information in the clinical UM guideline with their treating health care providers. 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. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. Price a medication, find a pharmacy,order auto refills, and more. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Search by keyword or procedure code for related policy information. Prior authorizations are required for: All non-par providers. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans.