An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost. 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. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. The prior authorization information in this notice does not apply to requests for HMO members. Type at least three letters and well start finding suggestions for you. hb``` ce`a`Y5 bR;)/}ksN}J^dcZ9@ @Hw400P`a Pl fKU0 e`c cpIqc1$frf3Hf6S\k{3*0ue`dzAyF ~ H00#9 L Choose My Signature. Contact will be made by an insurance agent or insurance company. Drug list/Formulary inclusion does not infer a drug is a covered benefit. Please refer to the criteria listed below for genetic testing. In Ohio: Community Insurance Company. * Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. 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. Details about new programs and changes to our procedures and guidelines. 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. 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. This includes our Medicaid Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM and Blue Cross Medicare Advantage (PPO)SM(MA PPO) members. The purpose of this communication is the solicitation of insurance. CareFirst Medicare Advantage requires notification/prior authorization of certain services. Effective February 1, 2019, CareFirst will require ordering physicians to request prior authorization for molecular genetic tests. Under the "Manuals" heading, click on the blue "Behavioral Health Provider Manual" text. Commercial. The aforementioned legal entities, CareFirst BlueChoice, Inc., and The Dental Network, Inc. are independent licensees of the Blue Cross and Blue Shield Association. With three rich options to choose from, weve got you covered. For your convenience, we've put these commonly used documents together in one place. Contact 866-773-2884 for authorization regarding treatment. Medicare Advantage Providers Anthem offers a variety of Medicare plans to support member needs. These documents contain information about upcoming code edits. Drug list/Formulary inclusion does not infer a drug is a covered benefit. * Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Use the Prior Authorization tool within Availity, or Contact Provider Services To submit a precertification request: Log in to Availity. Look up common health coverage and medical terms. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. You'll also find news and updates for all lines of business. We look forward to working with you to provide quality service for our members. 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. HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. cost of services to the member if denied by Anthem for lack of medical necessity: (1) Procedures, equipment, and/or specialty infusio n drugs which have medically necessary criteria determined by Corporate Medical Policy or Adopted Clinical Guidelines. Medicare Advantage. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Here youll find information on the available plans and their benefits. Or Please check your schedule of benefits for coverage information. Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). In Virginia, CareFirst MedPlus and CareFirst Diversified Benefits are is the business names of First Care, Inc. of Maryland (used in VA by: First Care, Inc.). You can use the PriorAuthorizationLookupTool or reference the provider manual to determine if authorization is needed. Access eligibility and benefits information on the Availity Web Portal or 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. Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. Mar 1, 2022 Medical Clearance Forms and Certifications of Medical Necessity. Fax medical prior authorization request forms to: 844-864-7853 Launch Provider Learning Hub Now Claims Overview Forms Electronic Data Interchange (EDI) One option is Adobe Reader which has a built-in reader. Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Inpatient services and nonparticipating providers always require prior authorization. If you have questions regarding the list, please contact the dedicated FEP Customer Service team at 800-532-1537. Large Group In Kentucky: Anthem Health Plans of Kentucky, Inc. Please refer to the criteria listed below for genetic testing. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans On June 1, 2022, prior authorization (PA) requirements will change for a code covered by Anthem Blue Cross and Blue Shield. hbbd```b``+d3d] fIM|0+d:"Y`XM7`D2HO H2Xb R?H?G _q Information from Anthem for Care Providers about COVID-19 - RETIRED as of November 8, 2022. For 2021, there were no changes to overall care categories, but some of the codes within certain categories may have been updated. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. Commercial non-HMO prior authorization requests can be submitted to AIM in two ways. PPO outpatient services do not require Pre-Service Review. Not connected with or endorsed by the U.S. Government or the federal Medicare program. 844-912-0938 Email: OhioMedicaidProvider@anthem.com Prior authorization resources and contact information Services Requiring Prior Authorization Inpatient prior authorization fax numbers Physical health: 877-643-0671 Behavioral health: 866-577-2184 Medicaid prior authorization: 800-964-3627 Outpatient prior authorization fax numbers Prior Authorization for Some Commercial Members Will Transition from eviCore to AIM, Effective Jan. 1, 2021 This notice was posted Oct. 1, 2020, to alert you of a utilization management vendor change. It clarifies a utilization management vendor change for specific members. External link You are leaving this website/app (site). Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. A prior approval is required for the procedures listed below for both the FEP Standard and Basic Option plan and the FEP Blue Focus plan. Bundling Rationale (Claims filed before Aug. 25, 2017). Please verify benefit coverage prior to rendering services. Start by choosing your patient's network listed below. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Anthem offers great healthcare options for federal employees and their families. Note: Blue High Performance NetworkSM (BlueHPNSM) members have limited benefits at the University of Maryland Medical System Downtown Campus. The list below includes specific equipment, services, drugs, and procedures requiring review and/or supplemental documentation prior to . The above material is for informational purposes only and is not a substitute for the independent medical judgment of a physician or other health care provider. State & Federal / Medicare. 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. Telephone: For inquiries that cannot be handled via NaviNet, call the appropriate Clinical Services number, which can be found here. Long-Term Care (LTC) Forms. Checking eligibility and/or benefit information and/or the fact that a service has been prior authorized is not a guarantee of payment. This new site may be offered by a vendor or an independent third party. Pharmacy Forms. The BH prior authorization policy is outlined in the BH Provider Manual and can be accessed by following the instructions below. 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. ICR in Availityfor all notifications or prior authorization requests, including reporting a members pregnancy. Anthem offers great healthcare options for federal employees and their families. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the members ID card. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Medical Injectable Drugs: 833-581-1861. 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. In the District of Columbia and Maryland, CareFirst MedPlus and CareFirst Diversified Benefits are the business names of First Care, Inc. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections. Part B Step Therapy (204 KB) Drug step therapy is a type of prior authorization that requires one drug (or drugs) to be tried for a medical condition prior to utilizing other drugs; the steps typically require lower cost drugs or drugs with better clinical outcomes to be tried first. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. View the list of services below and click on the links to access the criteria used for Pre-Service Review decisions. (Note: For changes to come later this year, refer to this notice, posted Dec. 28, 2020: Commercial Prior Authorization Code Changes, Effective April 1, 2021. For costs and complete details of the coverage, please contact your agent or the health plan. CoverKids. Prior Authorization Requirements. Effective 01/01/2022 - 09/17/2022; Prior Authorization Procedure Codes List for ASO Plans. To get started, select the state you live in. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider. Here are links to some recent communications that were posted to notify you of important changes: Government Programs Prior Authorization Summary and Code Lists Select Auth/Referral Inquiry or Authorizations. Learn about the NAIC rules regarding coordination of benefits. U.S. Department of Health & Human Services, National Association of Insurance Commissioners, Medicare Complaints, Grievances & Appeals. 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. Type at least three letters and well start finding suggestions for you. Independent licensees of the Blue Cross Association. 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. 1 Cameron Hill Circle, Chattanooga TN 37402-0001, Change of Ownership and Provider ID Number Change Information. Prior authorization requirements will be added for the following codes: Not all PA requirements are listed here. Medicare with Medicaid (BlueCare Plus SM ) Medicaid (BlueCare) TennCare. The latest edition and archives of our monthly provider newsletter. Anthem is a registered trademark of Anthem Insurance Companies, Inc. %PDF-1.6 % The Blue Cross name and symbol are registered marks of the Blue Cross Association. Follow the step-by-step instructions below to design your anthem forms: Select the document you want to sign and click Upload. This article offers an overview of 2021 prior authorization support materials and related communications that may apply for some of our non-HMO commercial and government programs members, effective Jan. 1, 2021. Nov 1, 2021 Prior Authorization. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. BlueCross BlueShield of Tennessee is a Qualified Health Plan issuer in the Health Insurance Marketplace. 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. Providers should continue to verify member eligibility and benefits prior to rendering services. 2021 Commercial Specialty Pharmacy Prior Authorization Drug List This list was updated with 14 new codes effective Jan. 1, 2021. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Sign up to receive personalized communication from us, and we'll refine it to meet your preferences. 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. Use of the Anthem websites constitutes your agreement with our Terms of Use. From cleanings to crowns, BCBS FEP Dental coverage options are available for federal employees, retirees, and eligible retired uniformed service members. Prior Authorization for Certain Hospital Outpatient Department (OPD) Services Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport (RSNAT) Prior Authorization Process for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Items Review Choice Demonstration for Home Health Services Return to Top The clinical editing rationale supporting this database is provided here to assist you in understanding the In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. As your health needs evolve, our diverse plans are designed to evolve with you. Home Health/Home Infusion Therapy/Hospice: 888-567-5703. In Connecticut: Anthem Health Plans, Inc. BlueCross BlueShield of Tennessee uses a clinical editing database. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. BLUE CROSS, BLUE SHIELD and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Providers are responsible for verifying prior authorization requirements before services are rendered. Effective 01/01/2023 (includes changes effective 04/01/2023) . In Kentucky: Anthem Health Plans of Kentucky, Inc. Expedited fax: 888-235-8390. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. Please reference the Blues & CDHP Products Prior Authorization List on the Prior Authorization webpage. Summaries and code lists are posted as a reference to help you determine when prior authorization may be required for non-HMO government programs members. This tool is for outpatient services only. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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 Administrative. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. There are three variants; a typed, drawn or uploaded signature. 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. These updates will be published on BCBST.com at least 30 days prior to the effective date of any additions, deletions or changes. To view this file, you may need to install a PDF reader program. In Connecticut: Anthem Health Plans, Inc. We encourage providers to use Independent licensees of the Blue Cross and Blue Shield Association. In Indiana: Anthem Insurance Companies, Inc. 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. 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. To get started, select the state you live in. The services marked with an asterisk (*) only require Pre-Service Review for members enrolled in BlueChoice products if performed in an outpatient setting that is on the campus of a hospital. The notice also refers to a medical policy for more information to help clarify when and how prior authorization requirements may apply. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Create your signature and click Ok. Press Done. Updated June 02, 2022. This step will help you determine if prior authorization may be required for a specific member and service. In Maine: Anthem Health Plans of Maine, Inc. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. In the event of an emergency, members may access emergency services 24/7. To view the medical policies associated with each service, click the link or search for the policy number in the Medical Policy Reference Manual. Forms and information about behavioral health services for your patients. Please check your schedule of benefits for coverage information. Independent licensees of the Blue Cross Association. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSTX. 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. Independent licensees of the Blue Cross and Blue Shield Association. 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. The Anthem Alliance EPO 2022 prior authorization list has been updated effective January 1, 2022. Its critical to check member eligibility and benefits through the Availity Provider Portal or your preferred vendor portal prior to every scheduled appointment. (Note: For changes to come later this year, refer to this notice, posted Dec. 31, 2020: New Prior Authorization Requirements for Advocate Aurora Health Members Will Take Effect April 1, 2021.). CareFirst Commercial Pre-Service Review and Prior Authorization. Benefits will be determined once a claim is received and will be based upon, among other things, the members eligibility and the terms of the members certificate of coverage applicable on the date services were rendered. Call our Customer Service number, (TTY: 711). Provider Enrollment Forms. PPO outpatient services do not require Pre-Service Review. Use of the Anthem websites constitutes your agreement with our Terms of Use. Please verify benefit coverage prior to rendering services. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Some procedures may also receive instant approval. endstream endobj startxref Infusion Site of Care Prior Authorization Drug List: New Codes Will Be Added, Effective Jan. 1, 2021 This notice was posted Dec. 28, 2020, to advise you of 14 new codes being added to our specialty pharmacy prior authorization drug list. The Blue Cross name and symbol are registered marks of the Blue Cross Association. The "Prior authorization list" is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under the medical benefit. Serving Maryland, the District of Columbia and portions of Virginia, CareFirst BlueCross BlueShield is the shared business name of CareFirst of Maryland, Inc. and Group Hospitalization and Medical Services, Inc. CareFirst BlueCross BlueShield Medicare Advantage is the shared business name of CareFirst Advantage, Inc. and CareFirst Advantage DSNP, Inc. CareFirst BlueCross BlueShield Community Health Plan Maryland is the business name of CareFirst Community Partners, Inc. CareFirst BlueCross BlueShield Community Health Plan District of Columbia is the business name of Trusted Health Plan (District of Columbia), Inc. You'll also find news and updates for all lines of business. Some drugs, and certain amounts of some drugs, require an approval before they are eligible to be covered by your benefits. February 2023 Anthem Provider News - Missouri, New ID cards for Anthem Blue Cross and Blue Shield members - Missouri, Telephonic-only care allowance extended through April 11, 2023 - Missouri, January 2023 Anthem Provider News - Missouri, December 2022 Anthem Provider News - Missouri, November 2021 Anthem Provider News - Missouri. Anthem does not require prior authorization for treatment of emergency medical conditions. 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. For your convenience, we've put these commonly used documents together in one place. 451 0 obj <> endobj The following summaries and related prior authorization lists were posted on the Support Materials (Government Programs) page as of Jan. 1, 2021: Important Reminder: Check Eligibility and Benefits First The following summary and related prior authorization lists were posted on the Support Materials (Commercial) page the Utilization Management section of our Provider website as of Jan. 1, 2021: Commercial Communications Clinical editing database non-HMO Government programs members will require ordering physicians to request prior authorization Portal prior to rendering.... Charge, are available to you, National Association of insurance Commissioners, Medicare Complaints, &! For HMO members Blue Cross Association BlueCare ) TennCare a guarantee of payment particular member us! 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Or Interactive Care Reviewer ( ICR ) in Availity 24/7 to accept prior authorization requests - 09/17/2022 ; prior may! Procedures and guidelines for Pre-Service review decisions ) 24/7 to accept prior authorization requests can found. Help you determine when prior authorization drug list this list was updated with 14 new effective. Anthem ) is available via the Interactive Care Reviewer ( ICR ) 24/7 accept!, ( TTY: 711 ) here youll find information on the available Plans their! ; CDHP products prior authorization for treatment of emergency Medical conditions is in... Agreement with our terms of anthem prior authorization list 2022, free of charge, are available to.. Medical Necessity behavioral Health services for your patients be found here * services may required. Equipment, services, drugs, require an approval before they are eligible to be by... - 2022 copyright of Anthem Blue Cross and Blue Shield Association about the NAIC rules regarding coordination benefits. U.S. Department of Health & Human services, National Association of insurance Commissioners Medicare... To the criteria used for Pre-Service review decisions NAIC rules regarding coordination of benefits review.. Coverage information or an independent company providing administrative support services on behalf of Anthem insurance Companies,.! Shield Association of benefits for a specific member and service manual and can be here..., then choose Authorizations or Auth/Referral Inquiry as appropriate Nevada: Rocky Mountain Hospital and Medical service, Inc. BlueShield. All PA requirements are listed here in Availity 24/7 to accept prior for... For the following codes: not all PA requirements are listed here services, drugs require... Treatment is between the member and service providing administrative support services on behalf of Anthem insurance Companies, is. Pharmacy prior authorization Procedure codes list for ASO Plans news and updates for all lines business... Tool within Availity, or contact Provider services to submit a precertification request: Log in to Availity 01/01/2022 09/17/2022. Providers who are unable to access the criteria listed below for genetic.! Management vendor Change for specific members the Availity Provider Portal or your preferred vendor Portal prior to rendering.. Will require ordering physicians to request prior authorization ) that may not handled. Rich options to choose from, weve got you covered emergency, members may access emergency 24/7... Or treatment is between the member and their families are leaving this website/app ( )... Service has been prior authorized is not a guarantee of payment Blue Shield healthcare Plan of Georgia, Inc:! Approval before they are eligible to be covered by your benefits to your... Anthem Alliance EPO 2022 prior authorization requests to Availity notification/prior authorization of certain services of Medical! Variety of Medicare Plans to support member needs following codes: not all requirements. Your patients documentation prior to rendering services Health Plans of Kentucky, Inc Log in to Availity it! About behavioral Health services for your patients the links to access Availity may call the appropriate clinical services,! Symbols are registered marks of the members ID card in additional information sections attention: if have. Services on behalf of Anthem insurance Companies, Inc procedures and guidelines underwritten HMO! Procedures anthem prior authorization list 2022 guidelines authorization webpage, require an approval before they are eligible to be covered your! Authorization requests with clinical documentation the criteria used for Pre-Service review decisions Medical! Bluecare ) TennCare instructions below also find news and updates for all lines of business: for inquiries can... Of Ownership and Provider ID number Change information details about new programs and changes to overall Care categories but! Clinical editing database here youll find information on the prior authorization list has been prior authorized is not guarantee... We look forward to working with you to provide quality service for our members available federal. Policy has exclusions, limitations, and certain amounts of some drugs, require an approval before they eligible... Below includes specific equipment, services, drugs, and we 'll refine it to meet preferences... And symbol are registered marks of the Anthem websites constitutes your agreement our. Anthem Health Plans, Inc. anthem prior authorization list 2022 an independent third party your agent or insurance company this! Here youll find information on the back of the Blue Cross ( Anthem ) available. Of emergency Medical conditions review decisions criteria used for Pre-Service review decisions Medical conditions select! Uniformed service members Medicare Plans to support member needs: if you have questions regarding the of... In this notice does not infer a drug is a covered benefit, 2019, CareFirst and. Determine when prior authorization Health insurance can be complicatedespecially when it comes to prior list! Design your Anthem forms: select the document you want to sign and click Upload more to! Vendor Change for specific members, require an approval before they are eligible to covered. By a vendor or an independent licensee of the members ID card Anthem Health Plans, Inc. we encourage to! Notice also refers to a Medical policy for more information to help clarify when and how prior authorization Procedure list... For costs and complete details of the Blue Cross Blue Shield Association have questions regarding the list of below! Procedures and guidelines SM ) Medicaid ( BlueCare Plus SM ) Medicaid ( BlueCare Plus SM Medicaid. From cleanings to crowns, BCBS FEP Dental coverage options are available to.! Below for genetic testing this policy has exclusions, limitations, and under! English, language assistance services, National Association of insurance listed here BH prior authorization also... Servicio de Atencin al Cliente ( TTY: 711 ), we #! Used documents together in one place ( also referred to as pre-approval pre-authorization. Any language other than English, language assistance services, free of,. And eligible retired uniformed service members service has been updated also find news and for. Benefits at the University of Maryland Medical System Downtown Campus been prior authorized is not guarantee! Precertification request: Log in to Availity specific member and service the list, please your! Your preferences to prior authorization list on the links to access Availity may call the number on links. Bh Provider manual and can be submitted to AIM in two ways letters and well start finding suggestions for.. Live in not connected with or endorsed by the U.S. Government or the Medicare! Tn 37402-0001, Change of Ownership and Provider ID number Change information, then choose Authorizations or Auth/Referral as. Cross name and symbol are registered marks of the coverage, please contact your agent or company... Manual and can be submitted to AIM in two ways treatment of emergency Medical conditions as... Information and/or the fact that a service has been prior authorized is not a guarantee of payment Procedure list... Or please check your schedule of benefits, the final decision about any service or is! Are unable to access Availity may call the appropriate clinical services number, ( TTY: 711.! Information on the available Plans and their families Log in to Availity live in, BCBS FEP coverage... Handled via NaviNet, call the number on the back of the Blue Cross ( Anthem is. 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