Your online account is a powerful tool for managing every aspect of your health insurance plan. Where is the Precertification Lookup Tool located on Availity? Deleted codes and their replacements, if applicable, add context to old or unfamiliar codes. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Use the Prior Authorization Lookup Tool within Availity or Contact the Customer Care Center: Outside Los Angeles County: 1-800-407-4627 Inside Los Angeles County: 1-888-285-7801 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 1-800-224-0336. Health Benefits for Federal Employees | Anthem This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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 were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. You can also visit bcbs.com to find resources for other states. Your browser is not supported. Anthem is a registered trademark of Anthem Insurance Companies, Inc. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. Your dashboard may experience future loading problems if not resolved. Prior Authorization Code Lookup 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.). New member? The purpose of this communication is the solicitation of insurance. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. 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. Compare plans available in your area and apply today. 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. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Use our library of self-paced courses and instructor-led training sessions, available 24/7 at no cost. To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. CHPW's Procedure Code Lookup Tool lets you search for services by procedure code and line of business to determine:. Access your member ID card from our website or mobile app. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all non-covered services (i.e., experimental procedures, cosmetic surgery, etc.) Our resources vary by state. Please verify benefit coverage prior to rendering services. Find drug lists, pharmacy program information, and provider resources. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Select Auth/Referral Inquiry or Authorizations. In Indiana: Anthem Insurance Companies, Inc. Call Provider Services at 1-800-454-3730 (TTY 711) After hours, verify member eligibility by calling the 24/7 Nurse HelpLine at 1-800-600-4441. This tool is for outpatient services only. Independent licensees of the Blue Cross and Blue Shield Association. The resources for our providers may differ between states. While the clinical UM guidelines developed by us are published on this web site, the licensed standard and customized MCG guidelines are proprietary to MCG and are not published on the Internet site. Choose your location to get started. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Please note that services listed as requiring precertification may not be covered benefits for a member. We offer flexible group insurance plans for any size business. Posted on December 7th, 2021 in Bulletin Board by Kianoush Moradian. Choose your location to get started. The medical policies do not constitute medical advice or medical care. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. If this is your first visit, be sure to check out the. Please note: This tool is for outpatient services only. Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. Our resources vary by state. Select Your State Precertification Lookup Tool | Healthy Blue Price a medication, find a pharmacy,order auto refills, and more. As the nations second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Understand your care options ahead of time so you can save time and money. 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. Jan 1, 2020 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. 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") Precertification lookup tool | Anthem Precertification lookup tool Please verify benefit coverage prior to rendering services. Additional medical policies may be developed from time to time and some may be withdrawn from use. We currently don't offer resources in your area, but you can select an option below to see information for that state. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. If you are unsure or have any questions, please be sure to check member eligibility and benefit coverage before proceeding with any authorization requests or services by contacting Provider Services at 800-901-0020. We look forward to working with you to provide quality service for our members. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the medical policies. 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. Please update your browser if the service fails to run our website. Choose your location 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. Procedure Code Lookup Tool - Washington State Local Health Insurance 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. You can access the Precertification Lookup Tool through the Availity Portal. Type at least three letters and well start finding suggestions for you. Please update your browser if the service fails to run our website. It looks like you're outside the United States. I didn't think Anthem was accepting codes 99251-99255, this maybe for the Medicare Products Only. Apr 1, 2022 Prior authorization lookup tool | Blue Cross MN Our call to Anthem resulted in a general statement basically use a different code. Inpatient services and nonparticipating providers always require prior authorization. Select a State Policies, Guidelines & Manuals We're committed to supporting you in providing quality care and services to the members in our network. We currently don't offer resources in your area, but you can select an option below to see information for that state. You can also reach Availity via phone at 1-800-AVAILITY (1-800-282-4548). Please Select Your State The resources on this page are specific to your state. 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. Checking the CMS ordering/referring provider downloadable report containing the NPI, first name, and last name of providers enrolled in PECOS. The resources for our providers may differ between states. 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. Medical Policies and Clinical UM Guidelines, HEDIS (The Healthcare Effectiveness Data & Information Set), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Members should discuss the information in the medical policies with their treating health care professionals. Out-of-state providers. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. Once youve accessed the Precertification Lookup Tool, choose a line of business from the menu selection offered, and then type the CPT/HCPCS code or a code description to determine if a prior authorization is required. If youre concerned about losing coverage, we can connect you to the right options for you and your family. 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. With Codify by AAPC cross-reference tools, you can check common code pairings. 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. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization. Please verify benefit coverage prior to rendering services. Self-Service Tools In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. 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. Enter a Current Procedural Terminology (CPT) code in the space below to get started. Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. We want to help physicians, facilities and other health care professionals submit claims accurately. List of CPT/HCPCS Codes | CMS - Centers for Medicare & Medicaid Services Access eligibility and benefits information on the Availity* Portal OR. 711. This tool is for outpatient services only. Members should contact their local customer service representative for specific coverage information. Prior Authorization Lookup Tool - Anthem Blue Cross We offer affordable health, dental, and vision coverage to fit your budget. Provider Communications Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Youll also strengthen your appeals with access to quarterly versions since 2011. State & Federal / Medicaid. We maintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. In Connecticut: Anthem Health Plans, Inc. Medical policy does not constitute plan authorization, nor is it an explanation of benefits. Choose your state below so that we can provide you with the most relevant information. If your state isn't listed, check out bcbs.com to find coverage in your area. Please verify benefit coverage prior to rendering services. 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. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. 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. In Ohio: Community Insurance Company. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. If you would like to request a hard copy of an individual clinical UM guideline or MCG guideline, please contact the member's health plan at the number on the back of their identification card. Benefit plans vary in coverage and some plans may not provide coverage for certain services discussed in the clinical UM guidelines. Do not sell or share my personal information. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Type at least three letters and we will start finding suggestions for you. Keep patients healthy and safe by becoming familiar with the tools and strategies useful in protecting yourself and our members against contagious illnesses. Copyright 2023. Use the Prior Authorization tool within Availity OR. Please verify benefit coverage prior to rendering services. The tool will tell you if that service needs . Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. We currently don't offer resources in your area, but you can select an option below to see information for that state. Lets make healthy happen. Click Submit. Health equity means that everyone has the chance to be their healthiest. Find drug lists, pharmacy program information, and provider resources. If you arent registered to use Availity, signing up is easy and 100% secure. The resources on this page are specific to your state. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. To get started, select the state you live in. Prior authorization lookup tool| HealthKeepers, Inc. For a better experience, please enable JavaScript in your browser before proceeding. Find a Medicare plan that fits your healthcare needs and your budget. Independent licensees of the Blue Cross and Blue Shield Association. Administrative / Digital Tools, Learn more by attending this live webinar. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Call our Customer Service number, (TTY: 711). Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. refer to your, Access eligibility and benefits information on the, Use the Prior Authorization within Availity OR. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy.