Ready Reference Guide UPDATE Anthem Blue Cross and Blue Shield in Ohio
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- Dominic Harmon
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1 Ready Reference Guide UPDATE in Ohio ***Reminder - always verify member eligibility and benefits with the member's benefit plan and verify your netwk participation with Anthem Ohio f the products listed, if necessary. Products Provider/ Customer Service Alpha- Prefixes Availity Paper Claims Address Appeals Address Provider Refunds (Contact Customer Service f the address f returning Anthem checks) Precertification (Precert including Retrospective Reviews)(Other Than Radiology) Case Management (CM) Local Products Blue Access Blue Preferred Blue Traditional Blue Access Options PPO f ERC Health 7/1/15 Blue Access Options PPO (Ohio Standard 3 Tier) 10/1/15 Group and Individual Policies: * CDHP/HDHP Plans: YRG, YRJ, YRL YRM, YRN, YRO, YRP, YRQ, YRT, YRB, YRY VXA XDV Ohio (Local) Anthem Products Precert: Peer to Peer: Fax: UM Appeals Fax: Predetermination of Benefits: CM: CM centregcmref@anthem.com Demographic, Admit and D/C Dates: Anthem.OhioAdmitting@anthem.com Clinical Infmation: Anthem.precert@anthem.com PT/OT - Orthonet eff 11/1/15: Phone: Fax: Via Genetic Testing eff 7/1/17 AIM Provider Ptal Musculoskeletal & Pain Mgmt eff 11/1/17 AIM Provider Ptal On Exchange - Individual: Pathway X Tiered PPO Netwk (limited netwk) Eff 1/1/16 Pathway X HMO Netwk (limited netwk) (855) JWR JWV Ohio On Exchange Individual Products
2 Off Exchange - Individual: Pathway Tiered PPO Netwk (limited netwk) Eff 1/1/16 Pathway HMO Netwk (limited netwk) (855) JWT YFS Ohio Off Exchange Individual Products On Exchange - Small Group: Blue Access Netwk (855) JWJ Ohio On Exchange Small Group (SHOP) Products Off Exchange - Small Group: Blue Access Netwk Eff 1/1/2017 Pathway HMO Netwk (limited netwk) Eff 1/1/18 Pathway Group HMO (855) JWQ YSY ZFZ Ohio Off Exchange Small Group Products Anthem Associates (HRA/HSA) WLU Anthem Associates Precert: UM Fax: CM: Diag Imaging, Sleep Therapy, Oncology Rx:
3 National (non-auto) Most have "AN" in 4th and 5th digits Eligibility, Claims Status, Links to National Precert: Peer to Peer: Fax: UM Appeals: UM Appeals Fax: CM: CM CM Fax: Request UM Criteria: Demographic, Admit and D/C Dates: Clinical Infmation: National (Auto) GM: Delphi: Fd-FGP: Fd-FSP: Chrysler: UAW: UGG and UFL (Medicare-MI): Facility: Eligibility and benefits Claims Professional: Eligibility and benefits Claims GM: Eligibility, Claims GHP,GIH, Status, Links to GMJ, GMH Delphi: DEH, DKP Fd: FGP, FSP Chrysler: DXP,DCH, DZW,DKP,DK M, NCH, DPU, DCC, NCH UAW: UGD,UGG,UF K,UFL, UCK,UDC Contract issues: Anthem Blue Cross and Benefit issues: member must appeal to BCBS MI Refer to patient ID card. Preauthization: Fax mail to: Blue Cross of Michigan P.O. Box 2227 Detroit, MI Mail code 0450 GM and Chrysler Radiology precert - AIM Specialty Health: Fax Chrysler Outpatient PT: handled by TheraMatrix eff 3/1/16 Phone: Web: GM GeoBlue QHH GeoBlue Provider Finder (BlueCard Netwk) BLUE Precert - route to BLUE Home Plan BlueCard Provider Service Refer to Member's ID Card BlueCard (Non-Ohio Blue Cross and Members' Plans) Infmation dependent upon ITS/Blue Card Dept availability from P.O. Box Blue Plan's frontend system Call the number on the back of the member's ID card Federal Employee Program (FEP) IVR: claim status, checks,, eligibility, benefits R Claim status (high level) Federal Employee Program (FEP) P.O. Box Clinical: Anthem Blue Cross Blue Shield Federal Employee Program Attention: Provider Appeals 3075 Vandercar Way Cincinnati, OH Non Clinical: PO Box Atlanta, GA 30348,, Precert: Peer to Peer: Fax: Fax - ABD: CM: Demographic, Admit, D/C and Clinical Infmation: fepe-reviews@anthem.com Federal requests f pre-determination can not be handled through e-review please refer provider to customer service number on the back of the member s card.
4 Medicare Supplement Products (termed 12/1/16) Eff 12/1/16 YRR (termed 12/1/16) VNE Eff 12/1/16 Seni Services Fax: No Precert f Medicare supplement plans. Medicare Advantage EMPLOYER GROUP eff 1/1/15 Anthem Seni Advantage HMO Anthem Medicare Preferred LPPO- Local PPO Blue Medicare Access RPPO- Regional PPO YRA (HMO) YRE (LPPO) YRS (RPPO) Claims, Links to Attn: Seni Appeals Mailstop: OH0205-A Irwin Simpson Rd. Mason OH Fax: Precertification: Fax - Inp notifications & all Outpatient: Fax- Facility Clinical: SNF, LTAC, Inpat Rehab: Fax f SNF, LTAC, Inpat Rehab: Predetermination of Benefits: Peer to Peer: P2P crp2p@anthem.com CM: opt. 4 CM CM-concierge@ wellpoint.com (all Central states) anthem.ohio.medicare@anthem.com Medicare Advantage INDIVIDUAL: Anthem MediBlue Essential (HMO) Anthem MediBlue Plus (HMO) Anthem MediBlue Prime Select (HMO) Eff 1/1/18 - Limited Cleveland Clinic Netwk Anthem MediBlue Access (PPO) Anthem MediBlue Access Plus (PPO) -new name 1/1/18 Anthem MediBlue Access Ce (RPPO) Anthem MediBlue Access Basic (RPPO) -new name 1/1/18 Anthem MediBlue Dual Advantage (HMO SNP) JRI VOC VOD JRG Claims, Links to Attn: Seni Appeals Mailstop: OH0205-A Irwin Simpson Rd. Mason OH Fax: Precertification: Fax - Acute Inp notifications & all Outpatient: Fax - Facility Clinical: SNF, LTAC, Inpat Rehab, Inpat non-acute: Fax f SNF, LTAC, Inpat Rehab, Inpat non-acute: SNF, LTAC, Acute Rehab Initial Concurrent reviews: OHDischargeplanning@anthem.com Predetermination: Peer to Peer: P2P crp2p@anthem.com CM: opt. 4 CM CentralRegioncmconcierge@anthem.com (all Central states) anthem.ohio.medicare@anthem.com Orthonet Phone: PT,OT (eff 7/1/16; therapy in SNF & LTC included) Spine & Back PM, Spinal Surgery Orthonet Fax: PT,OT (eff 7/1/16; therapy in SNF & LTC included) Spine & Back PM, Spinal Surgery Orthonet Cardiology eff 4/1/15: Ph Fx Outpat Radiation Oncology: AIM
5 Medicare Advantage- INDIVIDUAL continued Hearing Care Solutions: (877) Ptal: ProviderPtal.HearingCareSolutions.com NationsHearing: Eff 1/1/18 Phone: Website: Genetic Testing eff 11/1/17 AIM Provider Ptal Home Health via MyNexus eff 1/1/17: Use Fax Home Health Care Authization Request Fm to: Phone: Other Infmation Dental: Behavial Health Precert: CAQH: Orthonet Focused Claim Review **Commercial and Medicare Advantage Phone: Fax: Nthern Ohio: Central Ohio: Southern Ohio: Phone ; Hours 8:30 7:00 ET AIM Web Customer Service: Connect to AIM Precertification via: AIM Provider Ptal: Website: Clinical guidelines here Effective December 8, 2017, MyAnthem, the secure provider ptal f Anthem, will be retired. All infmation fmerly on MyAnthem will be exclusively on Availity. Availity ebusiness Help Desk: f issues with anthem.com Anthem infmation returned on Availity Availity: Phone: AIM Specialty Health Precertification technical ptal Issues - webcustomerservice@aimspecialtyhealth.com Optinet Surveys/Site Assessments Help Desk: optinetsuppt@aimspecialtyhealth.com Provider Solutions Eligibility and Benefits, Claims,, Precertification, Reimbursement Policies, Fee Schedules, Remits, MA Provider Self Service Retrospective Precertification AIM can enter cases retro 2 business days only. Eff August 22, these can be done online. After that timeframe, use the post service review/reconsideration process.* Anthem UM Services Fax f Local: *Medicare Advantage: No retros allowed. Effective in 2015, failure to obtain a pri authization will result in an administrative denial and members cannot be balance billed. Request f Claim Review, Adjustment Submitting Recds PO Box Fax: Include completed Provider Adjustment Request Fm, a letter with all pertinent claim and patient details. **If you receive a recd request letter, follow the instructions on the letter f returning them. Specialty Pharmacy Precertification - Does not include Specialty RX under Pharmacy Benefit National: check members ID card Commercial: Aimspecialtyhealth.com via Availity, Clinical Data Submission Tools available on the Anthem website/precertification specialtymeds@anthem.com Fax Level of Care Clinical Review Program: effective with dates of service on and after July 18, 2016 Medicare Advantage: Phone option 5, Fax with General Precert Fm (anthem.com Precertification page) Medicare Advantage maspecialtypharm@anthem.com Effective May 1, 2016 all oncology and oncology supptive specialty drugs that require pri authization f individual Medicare Advantage members will be reviewed f medical necessity through AIM s ProviderPtal by contacting AIM at FEP: submit ABD (with clinical) to fax Refunding Anthem Checks If you are returning a check issued by, please mail to: Anthem Finance Dept William Howard Taft Mail-Point: CW1-262 Cincinnati, Ohio EDI Solutions Help Desk: e-solutions.suppt@anthem.com Electronic Data Interchange Infmation Available Online: (Select OH & click enter) EDI Pay IDs: Professional ; Facility is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and names and symbols are registered marks of the Blue Cross and Association.
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