Use New Directions' WebPass tool. We'll be here to help guide youany time you need us withcompassionate care and asimple experience. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Box 68753 8:30 a.m. to 6 p.m. Click on the link below to view a complete list of pharmacies participating in the Performance Network. Note:It can take up to 30 days for a claim to be processed. March 2023 Anthem Provider News - Indiana, February 2023 Anthem Provider News - Indiana, New ID cards for Anthem Blue Cross and Blue Shield members - Indiana, Telephonic-only care allowance extended through April 11, 2023 - Indiana, January 2021 Anthem Provider News - Indiana. Pharmacy Information and Tools. Here to Help You. <> We promise to always deliver simple ways to get the medication you need. New Directions. In Maine: Anthem Health Plans of Maine, Inc. Medical and pharmacy strategies complement each other; theyre based on the same goals. Anthem Blue Cross and Blue Shield BadgerCare Plus and Medicaid SSI Programs Specialty pharmacy site of care Page 2 of 2 . Specialty drug list Anthem Blue Cross and Blue Shield Healthcare Solutions is contracted with Accredo as our exclusive pharmacy supplier for high-cost, specialty/injectable drugs that treat a number of chronic or rare conditions. Our drug lists allow members and their doctors to choose from a wide variety of prescription drugs. Motivating your patients to adhere to their medication can contribute to improved outcomes and increased STARS performance. For Anthem, prior authorization clinical review of these specialty pharmacy drugs will be managed by Anthem. Physicians and professionals: 1-800-344-8525 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. We look at our members holistically; offering coordinated medical and pharmacy benefits to help close gaps in care and improve members' overall heath. If you don't have an account yet, you can check claims for with our automated system. Get access to your online account.Register Now, Not registered? This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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. Monday through Friday Behavioral health services for Blue Cross Blue Shield of Michigan are managed by New Directions. Medicare Plus BlueSM PPO services are managed by Medicare Plus Blue Behavioral Health. Step 5:Tell the system the date of service provided. Box 33248 Important informationabout your 1095-B form. You get your health insurance plan from an employer or if you have certain grandfathered plans. 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. Log in at availity.com. 42I]?evMJz8q9|eszwdZL9}owq1}s&,/K{IP,xW^.` You can complete the process through your current electronic health record/electronic medical record (EHR/EMR) system or by using one of these ePA sites: We drive compliance to improve health and reduce costs. Find answers to all your questions with an Anthem representative in real time. P.O. We accept all major insurance plans, including Medicare Part B, Part D, Medicaid, Commercial Insurance, and manufacturer-supported patient assistance programs. It looks like you're outside the United States. P.O. Southfield, MI 48075, 1-877-293-2788 Whether you need advice from a pharmacist or training on injection techniques, our around-the-clock specialists are available via live chat now. Products & Programs / Pharmacy. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. You can write to us by matching your area code with the relevant mailing address. Step 6:Tell the system the total amount charged. If you're interested in joining the Physician Group Incentive Program, also known as PGIP, or want more information, emailvaluepartnerships@bcbsm.com. Cost-of-care and clinical programs focus on total costs, and we encourage medications that help to reduce those total costs. P.O. We offer affordable health, dental, and vision coverage to fit your budget. stream These pharmacies serve members with complex or chronic conditions. Beginning, April 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) is implementing a designated network for select specialty pharmacy medications administered in the office or the outpatient facility setting, Designated SRx Network. The automated system is available anytime. Physicians and professionals: 1-800-344-8525 You can find yours by selecting your region below. Get access to your agent portal. Our goal is to help improve your patients' health outcomes by combining medical, pharmacy and lab data ensuring coordination of our people, programs and . Compare plans available in your area and apply today. Help for members impacted by the winter storms emergency in California, March 2023 Anthem Blue Cross Provider News - California, Action required: 2023 Consumer Grievance and Appeals attestation Requirement, Group number change for Screen Actors Guild-American Federation of Television and Radio Artists Health Plan, June 2020 Anthem Blue Cross Provider News - California, Monday through Friday from 5 a.m. to 7:30 p.m. Pacific Time, Saturday from 6 a.m. to 10 a.m. Pacific Time. Jun 1, 2020 From easy online refills to one-on-one CareTeam support from specially trained nurses and pharmacists, we give patients the care they need, when and where they need it. If you have questions or need assistance, we're always here to help. Step 4: Say "yes" when asked if you have additional questions about the determination of the claim. Say "representative" to reach someone who can help. Blue Cross Blue Shield of Michigan. Use of the Anthem websites constitutes your agreement with our Terms of Use. Birmingham, AL 35238-0518. We look forward to working with you to provide quality service for our members. Check ereferrals.bcbsm.com for detailed prior authorization information. Find yours in our list ofphysician organization consultants (PDF). Available for iOS and Android devices. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Please update your browser if the service fails to run our website. Automated information is available anytime. We've gathered resources and tools to help you work as efficiently and productively as possible and do what you do best- care for our members. The purpose of this communication is the solicitation of insurance. Federal Employee Program providers and facilities: 1-800-840-4505. We currently don't offer resources in your area, but you can select an option below to see information for that state. Get access to your employer portal. There is no cost for this service. Hospitals or facilities: 1-800-249-5103. CVS Specialty dedicated Anthem Provider Services: Phone number: 1-877-254-0015 Fax: 1-866-336-8479 Hours of operation: Monday through Friday from 5 a.m. to 7:30 p.m. Pacific Time Saturday from 6 a.m. to 10 a.m. Pacific Time * CVS Specialty is an independent company providing specialty pharmacy services on behalf of Anthem. We currently don't offer resources in your area, but you can select an option below to see information for that state. The resources for our providers may differ between states. Blue Care Network Step 5: Tell the system the date of service provided. The Rx Choice Tiered Network may not be available in all states. It looks like you're in . Get the mobile app We've gathered resources and tools to help you work as efficiently and productively as possible and do what you do best- care for our members. 1-800-822-2761 Dental providers who can't able to access their account can read theDental Summary Guide (PDF)to learn how to: To use the document, you'll need to know if your patient has a Medicare Advantage plan, Federal Employee Program plan or a commercial plan. Don't have a secured provider portal account yet? 8:30 a.m. to noon and 1 to 5 p.m. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? 1-844-876-7917 endobj We engage members and you, their doctors. The Availity Portal offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer. Say "fax or email" to receive a copy of your claim's status. When you email us, we'll call . CVS Specialty helps patients with complex conditions manage their medications and live their best lives. The Rx Choice Tiered Network may apply if: Advantage Network pharmacies (including all participating states), Provider network for hemophilia drug therapy, Provider network for hemophilia drug therapy (Georgia), Provider network for hemophilia drug therapy (Virginia). We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Or Step 7:Listen to your claim's status, which includes the following information: Step 8: After listening to the claim's status, you'll have the following choices: The automated system is available anytime. We support specialty treatments and take a hands-on approach to patient care that makes a meaningful imprint on the health and quality of life of each patient. If specialty medications are obtained through other pharmacies, the claim will be denied. The Blue Cross name and symbol are registered marks of the Blue Cross Association. CVS Specialty and Hemophilia Treatment Centers on the list are considered in-network and will give you lower costs for your Factor treatment under the medical benefit. P.O. Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader. Say "date of service" to learn about a different claim. 3 0 obj We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Vision and hearing providers: 1-800-482-4047. The Pharmacy Home Program identifies members who may be over-utilizing providers, medications and pharmacies to obtain controlled substances. Our goal is to help improve your patients' health outcomes by combining medical, pharmacy and lab data ensuring coordination of our people, programs and knowledge. On April 1, 2020, Anthem notified physicians that it will soon require that specialty pharmacy medications administered in the office or outpatient hospital setting be obtained exclusively through CVS Specialty pharmacy. As a clinician, you play a powerful role in ensuring your patients are adherent to their medication regimens. We believe the right drugs to cover are the ones that do the best job for our members and reduce the total cost of care. Anthem ( NYSE: ANTM ) is one of the largest managed care organizations in the United States. 1-800-249-5103 Mailing address for medical records for authorizations, Essential Vision providerssubmit claims through. These pharmacies serve members with complex or chronic conditions. Call our Customer Service number, (TTY: 711). Preferred Drug List and Formulary Search In Indiana: Anthem Insurance Companies, Inc. Blue Cross Blue Shield of Michigan We help you find the lowestprices for the most effectivemedication. Box 312599 The resources for our providers may differ between states. For a step-by-step guide to Electronic Data Interchange, also known as EDI, read our FAQ on the topic. See what specialty pharmacies are considered in-network. Step 5: Tell the system the date of service. The resources on this page are specific to your state. Individuals attempting unauthorized access will be prosecuted. P.O. When you write the new prescription, you can fax or efax the form and prescription to the phone number on the form. This allows us to send generic and therapeutic equivalent messages with member-specific cost savings. Your dashboard may experience future loading problems if not resolved. We send members personalized messages about medications that may reduce their costs and include specific cost savings. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. Federal Employee Program providers and facilities: 1-800-482-3600 If you have any questions about your pharmacy benefits, call Pharmacy Member Services at 1-833-207-3120 (TTY 711) 24 hours a day, seven days a week. IngenioRx Specialty Pharmacy provides your specialty medications. You can also visit bcbs.com to find resources for other states. If you're not a Blue Vision provider, send claims to: VSP Make your mental health a priority. If you have questions, please contact your group administrator or your Anthem network representative. The resources for our providers may differ between states. Monday through Friday. Your online account is a powerful tool for managing every aspect of your health insurance plan. For costs and complete details of the coverage, please contact your agent or the health plan. Your dashboard may experience future loading problems if not resolved. Members dont receive multiple letters focused on individual clinical and cost-of-care programs. 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. Members taking specialty drugs may need to get their prescription filled at an in-network specialty pharmacy in order for their drug to be covered under their pharmacy or medical benefit. <>>> Automated information is available anytime. 8 a.m. to 6 p.m. New member? Note: The FEP phone system has a different set of prompts than the others. We see how drugs work in our members real lives and help them make good health care choices. Hospitals or facilities: 1-800-249-5103 You can even get reminders when you need a refill. What you need to know about the coronavirus, COVID-19. 8:30 a.m. to noon and 1 to 5 p.m. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. 8 a.m. to 5 p.m. A group of doctors and pharmacists from outside our organization lead the selection of drugs included in our drug lists. Quickly and easily submit out-of-network claims online. Blue Cross Blue Shield of Michigan 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. out of your benefits, find the best healthcare, and stay healthy. Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. <> Call Member Services at Providers should continue to submit for administration of the medication, but not bill for the medication itself. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Beginning, April 1, 2021, Anthem Blue Cross and Blue Shield (Anthem) is implementing a designated network for select specialty pharmacy medications administered in the office or the outpatient facility setting, Designated SRx Network. As one of the nation's leading health plans, Anthem serves millions of members in state-sponsored programs across the nation. AINPEC-2262-19 October 2019 Specialty Drug List If your state isn't listed, check out bcbs.com to find coverage in your area. 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. Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state. We use Availity Essentials as our provider portal. The automated system is available anytime. In Connecticut: Anthem Health Plans, Inc. Manage your medicine from anywhere with the Sydney Health mobile app With the free app, you can: We encourage medications that improve patient health. Detroit, MI 48226. Monday through Friday. By using targeted, concise communication, we help members make good health care choices and improve health outcomes. 8:30 a.m. to noon and 1 to 5 p.m. 1996-2023 Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association. Pharmacy Information for Providers We look at our members holistically; offering coordinated medical and pharmacy benefits to help close gaps in care and improve members' overall heath. Step 2 - In "Patient Information", provide the patient's full name, phone number, full address, date of birth, sex (m/f), height, and weight. Creating an account is free, easy and helps patients get their medications sooner. The Base Network is our national pharmacy network and includes nearly 70,000 retail pharmacies across the country. Step 2: Answer the prompts about your patient and whether you provided care in Michigan. 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., 2022. This applies to all Anthem Indiana commercial members. 1-800-482-4047 Refill and track your specialty drug prescriptions, pay online, and get live support. Once we identify a gap in care, the member receives a personalized Medication Review, which contains pharmacy messaging for our clinical and cost-of-care programs in one consolidated, health plan-branded, monthly member communication. Just keep in mind you'll need to go through the prompts before you're connected to someone. If you're already a member, you can email us at DirectoryRequest_MMP@anthem.com to ask for a printed Drug List. Submit prior authorization requestselectronicallythrough CoverMyMeds. Step 6: Tell the system the total amount charged. IngenioRx* is the pharmacy benefits manager. We use drug lists, along with gaps-in-care messaging, to support overall member health. A specialty pharmacy does more than just fill prescriptions. This will have no impact on how members obtain non-specialty pharmacy medications at retail pharmacies or by mail-order. 1-800-762-2382 8:30 a.m. to 6 p.m. Monday through Friday. This applies to all specialty drugs covered through the Medicaid health maintenance organization (HMO) members medical benefits where Anthem has financial risk for the cost of specialty medications. L07B Not connected with or endorsed by the U.S. Government or the federal Medicare program. It can also send you a copy of your claim's status. Automated information is available anytime. 1-888-826-8152 submittal. You can also visit bcbs.com to find resources for other states. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. 8 a.m. to 7 p.m. Grand Rapids, MI 49523-0589, Provider Inquiry You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. You can also talk to your provider consultant. You can also use these documents for guidance: Have your NPI, Tax ID or Social Security number ready before calling. IngenioRx is a separate company that provides pharmacy services and pharmacy benefit management services on behalf of Anthem Blue Cross and Blue Shield. For Michigan Providers: Summary of Utilization Management Programs (PDF), Provider Prior Authorization and Precertification Requirements for BCBSM and Medicare Plus Blue, For Michigan Providers: BCN Referral and Prior Authorization Requirements (PDF), For Non-Michigan providers: Referral and Authorization Requirements (PDF), Important Information About MedicarePlans, Your 10-digit national provider identifier, BCBSM PIN or facility code, The members contract number, date of birth, the spelling of their first name and their ZIP code, Member liability, including deductible, coinsurance and copays. Call Pharmacy Member Services toll free at 1-833-370-7466 (TTY: 711) 24 hours a day, 7 days a week to ask us to mail you a Drug List. 20500 Civic Center Drive If youre an administrative office of a medical care group, you have access to a professional organization consultant. Monday through Friday Anthem Blue Cross (Anthem) is pleased to offer CVS Specialty* as our designated specialty pharmacy for specialty medications administered in the office or outpatient hospital setting. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Anthem is a registered trademark of Anthem Insurance Companies, Inc. If you're notanEssential Vision provider, send claims to: Heritage Vision Plans, Inc. Explore our comprehensive guides and video resources for more information regarding your condition. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Register Now, Not registered? Members have one vendor, one contact, and one ID card. Providing care for those who need it most requires a team effort. Understand your care options ahead of time so you can save time and money. Download Adobe Acrobat Reader programs specialty pharmacy site of care Page 2 of 2 system has different. 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