website and are no longer accessing or using any ABCBS Data. Use Availitys electronic authorization tool to quickly see if a pre-authorization is required for a medical service or submit your medical pre-authorization request. Noncompliance with new requirements may result in denied claims. Type at least three letters and well start finding suggestions for you. InteractiveCare Reviewer is a utilization management tool that lets you submit prior authorization requests and other clinical information quickly and easily. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services. In Indiana: Anthem Insurance Companies, Inc. Prior authorization contact information for Empire Providers and staff can also contact Empire for help with prior authorization via the following methods: Empire Provider Services Phone: 1-800-450-8753 Hours: Monday to Friday 8:30 a.m. to 5:30 p.m. Fax: 1-800-964-3627 Empire Pharmacy Department This tool does not reflect benefits coverage, Access eligibility and benefits information on the, Use the Prior Authorization Lookup Tool within Availity. You are invited: Advancing Mental Health Equity for Youth & Young Adults. Below that, write the name of the requester (if different than the prescriber) and supply the prescribers NPI number and DEA number. 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. Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements. February 2023 Anthem Provider News - Ohio, New ID cards for Anthem Blue Cross and Blue Shield members - Ohio, Telephonic-only care allowance extended through April 11, 2023 - Ohio, C1764 Event recorder, cardiac (implantable), E0720 Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized, E0730 Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, G0460 Autologous platelet rich plasma for chronic wounds/ulcers, including phlebotomy, centrifugation, and all other preparatory procedures, administration and dressings, per treatment, L3000 Foot insert, removable, molded to patient model, UCB type, Berkeley shell, each, L3031 Foot, insert/plate, removable, addition to lower extremity orthosis, high strength, L3170 Foot, plastic, silicone or equal, heel stabilizer, prefabricated, off-the-shelf, each, L3310 Lift, elevation, heel and sole, neoprene, per inch, L3332 Lift, elevation, inside shoe, tapered, up to one-half inch, L3580 Ortho shoe add instep Velcro closure, L3610 Transfer of an orthosis from one shoe to another, caliper plate, new, L3620 Transfer of an orthosis from one shoe to another, solid stirrup, existing, L3630 Transfer of an orthosis from one shoe to another, solid stirrup, new, L3649 Orthopedic shoe, modification, addition or transfer, not otherwise specified, L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf, L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf, L3761 Elbow orthosis (EO), with adjustable position locking joint(s), prefabricated, off-the-shelf, L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-the-shelf, L3807 Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise, L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type, L3912 Hand-finger orthosis (HFO), flexion glove with elastic finger control, prefabricated, off-the-shelf, L3913 HFO, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment, L3923 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise. We look forward to working with you to provide quality service for our members. View requirements for group and Individual members on our commercial products. Or if you are calling about a specific case, they will direct your call to the appropriate prior authorization staff. Fax the completed form to 1-844-429-7757 within one business day of the determination/action. View the FEP-specific code list and forms. Type at least three letters and we will start finding suggestions for you. To learn more read Microsoft's help article. or sexual orientation.Premera Blue Cross HMO complies with applicablefederal and Washington state civil rights lawsand does not discriminate on the basis of race, The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. You can also visit, Standard Local Prior Authorization Code List, Standard Prior Authorization Requirements, SHBP Precertification Procedure Codes Sheet, SHBP Co-pay/Co-insurance Waiver Medication List. Availity is solely responsible for its products and services. Check whether a prior authorization is needed Check the status of a prior authorization This information is also available in other ways to people with disabilities by calling customer service at (651) 662-8000 (voice), or 1-800-382-2000 (toll free). Use of the Anthem websites constitutes your agreement with our Terms of Use. CareMore Health is a leading primary care provider that specializes in chronic and complex conditions. Step 13 The prescriber must provide their signature at the bottom of the form and the date of signing. Please note that CVS Caremark administers the pharmacy benefits for the State Health Benefit Plan. To stay covered, Medicaid members will need to take action. In Kentucky: Anthem Health Plans of Kentucky, Inc. Therefore, its important for you to know your benefits and covered services. We currently don't offer resources in your area, but you can select an option below to see information for that state. Also, specify any allergies and give the name and phone number of the patients authorized representative (if applicable). Anthem partners with health care professionals to close gaps in care and improve members overall heath. As of November 8, 2022, THIS DOCUMENT WILL NO LONGER BE UPDATED. Prior authorization contacts vary for Shared Administration groups.View the Shared Administration contact list for details. may be offered to you through such other websites or by the owner or operator of such other websites. Prior authorization requirements will be added for the following codes: Not all prior authorization requirements are listed here. Prior authorization is not a guarantee of payment. The Internet Explorer 11 browser application will be retired and go out of support on June 15, 2022. Weve provided the following resources to help you understand Anthems prior authorization process and obtain authorization for your patients when its required. Online - The AIM ProviderPortal is available 24x7. However, if you receive services that are not medically necessary from a provider not contracting with Blue Cross of Idaho, you may be responsible for the entire cost of the services. Posted Jan. 11, 2021. Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc.). 2023 Regence health plans are Independent Licensees of the Blue Cross and Blue Shield Association serving members in Idaho, Oregon, Utah and select counties of Washington. 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 In the event that the emergency room visit results in the members admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. In Connecticut: Anthem Health Plans, Inc. If you choose to access other websites from this website, you agree, as a condition of choosing any such Do not sell or share my personal information. In the case of an emergency, you do not need prior authorization. Inpatient services and nonparticipating providers always require prior authorization. Step 12 On page 2 (3), provide any details supporting the request (symptoms, clinic notes, lab results, etc.). Medical and Behavioral Health Procedure Codes Requiring Prior Authorization: Providers please note that as of the 2/1/2022 Prior Authorization release, we are moving to one document that includes authorization requirements for Medical, Durable Medical Equipment, eviCore, and Behavioral Health rather than individual documents for each specialty. Prior authorization is the process of obtaining coverage approval for a medical or behavioral health service or procedure in advance of treatment. Prior Authorization details for providers outside of WA/AK. ), 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.