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Understand your care options ahead of time so you can save time and money. We offer flexible group insurance plans for any size business. 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. Or 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 currently don't offer resources in your area, but you can select an option below to see information for that state. Coverage decisions are subject to all terms and conditions of the applicable benefit plan, including specific exclusions and limitations, and to applicable state and/or federal law. Medicare Complaints, Grievances & Appeals. Our research shows that subscribers using Codify by AAPC are 33% more productive. 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. State & Federal / Medicaid. 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. Line of Business: Hoosier Care Connect, Anthem Blue Cross and Blue Shield Member site. Your dashboard may experience future loading problems if not resolved. 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. National Accounts, Posts about using health Insurance and managing your health, Collections of learning resources and links to services, For Sydney Health users connect with others and find care programs. With Codify by AAPC cross-reference tools, you can check common code pairings. 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). Benefit Lookup by Procedure Code Webinar Tuesday, April 12, 2022 11 to 11:45 a.m. March 2023 Anthem Provider News - Missouri, 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, April 2022 Anthem Provider News - Missouri, enable member benefit lookup by CPT and HCPC procedure codes, Enter up to eight procedure codes per transaction, provide additional cost share information by place of service, return Is Authorization Required? information, include additional plan-level benefit limitations. Do not sell or share my personal information. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). 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. Find a Medicare plan that fits your healthcare needs and your budget. Please update your browser if the service fails to run our website. Administrative / Digital Tools, Learn more by attending this live webinar. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Choose your location to get started. You can access the Precertification Lookup Tool through the Availity Portal. We look forward to working with you to provide quality service for our members. Choose your state below so that we can provide you with the most relevant information. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. You can also visit. A clinical UM guideline does not constitute plan authorization, nor is it an explanation of benefits. Our NCCI Edit tool will help you prevent denials from Medicares National Correct Coding Initiative edits. Use our app, Sydney Health, to start a Live Chat. Interested in joining our provider network? Enter a Current Procedural Terminology (CPT) code in the space below to get started. 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. Provider Policies, Guidelines and Manuals | Anthem.com Find information that's tailored for you. Home Employer Federal Employees Blue Cross And Blue Shield Service Benefit Plans Medical Plans Review medical and pharmacy benefits for up to three years. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. For costs and complete details of the coverage, please contact your agent or the health plan. 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. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. COVID-19 Information - Ohio - Publication RETIRED as of November 8, 2022. You can also visit bcbs.com to find resources for other states. 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. Your browser is not supported. We look forward to working with you to provide quality services to our members. Please update your browser if the service fails to run our website. Choose your location to get started. Navigate to the Precertification Lookup Tool on the Availity Portal by selecting either 1) Payer Spaces or 2) Patient Registration from Availitys homepage. Because local practice patterns, claims systems and benefit designs vary, a local plan may choose whether to implement a particular clinical UM guideline. Independent licensees of the Blue Cross and Blue Shield Association. Plus, you may qualify for financial help to lower your health coverage costs. The resources for our providers may differ between states. They are not agents or employees of the Plan. If your state isn't listed, check out bcbs.com to find coverage in your area. 711. Access resources to help health care professionals do what they do bestcare for our members. Treating health care providers are solely responsible for diagnosis, treatment and medical advice. It looks like you're in . We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. 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. Treating health care professionals are solely responsible for diagnosis, treatment and medical advice. No provider of outpatient services gets paid without reporting the proper CPT codes. 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") Easy access CPT Assistant archives, published by the AMA, and the AHA Coding Clinic. Use the Precertification Lookup Tool accessed through Payer Spaces in Availity. 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 purpose of this communication is the solicitation of insurance. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Members should discuss the information in the medical policies with their treating health care professionals. Our resources vary by state. The resources for our providers may differ between states. For a better experience, please enable JavaScript in your browser before proceeding. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. * Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Call Provider Services at: 833-405-9086 To request authorizations: From the Availity homepage, select Patient Registration from the top navigation. The resources for our providers may differ between states. The resources for our providers may differ between 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. CPT guidelines indicate these services are reported only by the admitting/supervising provider; all other providers should report 99231-99233 or 99251-99255. Medicaid renewals will start again soon. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States.