anthem blue cross prior authorization list

Anthem does not require prior authorization for treatment of emergency medical conditions. Located in neighborhoods all over the country, CareMore Health Care Centers combine a variety of different specialty services under one roof. Step 5 In Medication / Medical and Dispensing Information, specify the medication name and indicate whether or not the request is a new therapy or a renewal (if renewal, specifythe date therapy started and the duration). Complete all member information fields on this form: Complete either the denial or the termination information section. If you're concerned about losing coverage, we can connect you to the right options for you and your family. ABCBS makes no warranties or representations of any kind, express or implied, nor Secondly, it can be frustrating when a service not covered by your contract is performed by your doctor or specialist. Use of the Anthem websites constitutes your agreement with our Terms of Use. Out-of-area providers In Kentucky: Anthem Health Plans of Kentucky, Inc. Anthem has also made available a series of forms for specific medications which may provide more efficient service when making a request. Step 3 In Insurance Information, provide the primary and secondary insurance providersalong with the corresponding patient ID numbers. 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. 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. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. Availity is an independent provider of health information network services that does not provide Blue Cross Blue Shield products or services. Administrative. We look forward to working with you to provide quality service for our members. In Indiana: Anthem Insurance Companies, Inc. 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. Your contract lists covered services, like a wellness exam, immunization or a diagnostic test. Updated June 02, 2022. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. . Future updates regarding COVID-19 will appear in the monthly Provider News publication. Prior Authorization Requirements - Blue Cross MN Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. Provider Communications Some procedures may also receive instant approval. We're encouraging our users to go ahead and switch to Microsoft Edge, Google Chrome, Safari or Firefox. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. Please note that CarelonRx is the pharmacy benefits manager for Medicare Advantage plans. affiliates, its directors, officers, employees and agents ("the ABCBS Parties") are not responsible for ), 33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation, 33361 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; percutaneous femoral artery approach, 33362 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open femoral artery approach, 33363 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; open axillary artery approach, 33365 Transcatheter aortic valve replacement (TAVR/TAVI) with prosthetic valve; transaortic approach (eg, median sternotomy, mediastinotomy), 33418 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; initial prosthesis, 33419 Transcatheter mitral valve repair, percutaneous approach, including transseptal puncture when performed; additional prosthesis(es) during same session (List separately in addition to code for primary procedure), 33477 Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed, 33979 Insertion, Ventricular Assist Device, Implantable Intracorporeal, Single Ventricle, 33990 Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only, 36514 Therapeutic Apheresis; Plasma Pheresis, 37215 Transcatheter placement of intravascular stent(s), cervical carotid artery, percutaneous; with distal embolic protection, 55874 Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed, A4224 Supplies for maintenance of insulin infusion catheter, per week, A4225 Supplies for external insulin infusion pump, syringe type cartridge, sterile, each, A5503 For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom molded shoe with roller or rigid rocker bottom, per shoe, A5512 For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees Fah, A5513 For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of Shore A 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each, A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries, C1722 Cardioverter-defibrillator, single chamber (implantable), L5671 Addition to lower extremity, below knee (BK)/above knee (AK) suspension locking mechanism (shuttle, lanyard, or equal), excludes socket insert, L5673 Addition to lower extremity, below knee/above knee, custom fabricated, L5679 Addition to lower extremity, below knee/above knee, custom fabricated, L5968 Addition to lower limb prosthesis, multiaxial ankle with swing phase active dorsiflexion feature, L5981 All lower extremity prostheses, flex-walk system or equal, L5987 All lower extremity prostheses, shank foot system with vertical loading pylon, L8699 Prosthetic implant, not otherwise specified, L9900 Orthotic and prosthetic supply, accessory, and/or service component of another HCPCS L code. third-party website link available as an option to you, ABCBS does not in any way endorse any such website, Online - The AIM ProviderPortal is available 24x7. Inpatient services and nonparticipating providers always require prior authorization. View the FEP-specific code list and forms. 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. Let us know! By using the website, you agree to our use of cookies to analyze website traffic and improve your experience on our website. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. The CarelonRx member services telephone number is 833-279-0458. Easily obtain pre-authorization and eligibility information with our tools. URAC Accredited - Health Plan with Health Insurance Marketplace (HIM) - 7.3, URAC Accredited - Health Utilization Management - 7.4, Member forms - Individual and family plans, Coverage policy and pre-certification/pre-authorization, Approval information for radiological services, Medicare Advantage Prior Authorization Request Form, Part B Medication Prior Approval Request Form, Check deductible and out-of-pocket totals. Prior-Authorization And Pre-Authorization | Anthem.com Medical Policy and Prior Authorization for Blue Plans. | Deutsch | Expand All Have you reviewed your online provider directory information lately? or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, Submitting Prior Authorization | Provider | Premera Blue Cross | In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We currently don't offer resources in your area, but you can select an option below to see information for that state. We also want to ensure you receive the right technology that addresses your particular clinical issue. 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 We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. We look forward to working with you to provide quality services to our members. It looks like you're in . In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. We currently don't offer resources in your area, but you can select an option below to see information for that state. | Type at least three letters and we will start finding suggestions for you. Please update your browser if the service fails to run our website. Type at least three letters and well start finding suggestions for you. 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. If you choose to access other websites from this website, you agree, as a condition of choosing any such Prior authorization is not a guarantee of payment. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. There is a list of these services in your member contract. PDF Authorization requirements by product - Blue Cross Blue Shield of Please verify benefit coverage prior to rendering services. An Anthem (Blue Cross Blue Shield) prior authorization form is what physicians will use when requesting payment for a patient's prescription cost.

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