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. You can also use these documents for guidance: Have your NPI, Tax ID or Social Security number ready before calling. We encourage medications that improve patient health. If you call before 30 days, we may not be able to check your claim through our automated phone system. 8:30 a.m. to noon and 1 to 5 p.m. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. With the Rx Choice Network, you can choose from two levels of coverage, helping to provide both savings and access: Level 1: You can get prescriptions filled at Level 1 pharmacies for the same copay or percentage of the drug costs you usually pay as part of your prescription drug plan. Use our app, Sydney Health, to start a Live Chat. Drugs used for the treatment of Oncology will still require pre-service clinical review by AIM. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Get translation and interpretation services free of charge. You can also visit bcbs.com to find resources for other states. Scroll down and select Pharmacy in the Category drop down. Pharmacy Information and Tools. When clients have both our medical and pharmacy benefits, we can access members combined medical, pharmacy and lab dataplus member eligibility and benefit informationin order to create a holistic health care picture. Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 a.m. to 8 p.m. ET/CT, 7 a.m. to 7 p.m. MT/PT. Search for specific text by using your Find function (Ctrl+F or Command+F). Box 310166 The automated system is available anytime. P.O. There, you can log in to refill, manage, and sign up for home delivery. You can even get reminders when you need a refill. Important informationabout your 1095-B form. Step 2: Answer the system's prompts about your patient and whether you provided care in Michigan. CVS Specialty dedicated Anthem Provider Services: Anthem Blue Cross is the trade name of Blue Cross of California. TTY users: To reach any number listed here, dial 711. These pharmacies serve members with complex or chronic conditions. <>>>
By using targeted, concise communication, we help members make good health care choices and improve health outcomes. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Providers may continue to submit a claim for administration of the specialty pharmacy medications, which will be reimbursed at the current contracted rates. What you need to know about the coronavirus, COVID-19. Note: The FEP phone system has a different set of prompts than the others. 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. Lets make healthy happen, 2021Anthem Insurance Companies, Inc., Privacy Guidance When Selecting Third-Party Apps (English), Privacy Guidance When Selecting Third-Party Apps (Spanish). Essential Vision providerssubmit claims throughHeritage Vision Plan. 1-800-482-4047 If you're not a Blue Vision provider, send claims to: VSP 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. Medical and pharmacy strategies complement each other; theyre based on the same goals. 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. 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. We promise to always deliver simple ways to get the medication you need. We look at our members holistically; offering coordinated medical and pharmacy benefits to help close gaps in care and improve members overall heath. 1-800-249-5103 PO Box 385018 CVS Specialty dispenses a wide array of specialty medication used to treat many health conditions. A specialty pharmacy does more than just fill prescriptions. Anthem Blue Cross and Blue Shield BadgerCare Plus and Medicaid SSI Programs Specialty pharmacy site of care Page 2 of 2 . Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc., an independent licensee of the Blue Cross and Blue Shield Association. IngenioRx Specialty Pharmacy provides your specialty medications. 1-888-826-8152 If youre an administrative office of a medical care group, you have access to a professional organization consultant. Level 2: For an extra copay or percentage of the drug cost (depending on your benefit), you have more choices with Level 2 pharmacies, no matter which drug you fill. 2 0 obj
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. 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. If you are a member with Anthems pharmacy coverage, click on the link below to log in and search for network pharmacies. Products & Programs / Pharmacy. Please update your browser if the service fails to run our website. Southfield, MI 48075, 1-877-293-2788 New member? We currently don't offer resources in your area, but you can select an option below to see information for that state. Monday through Friday 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. Well take it from there. 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 1-855-504-2583 Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader. Hospitals or facilities: 1-800-249-5103. This group performs regular clinical reviews, rates drugs based on how they work in real life, evaluates drug costs to make sure they are affordable, and chooses drugs that are safe, work well and offer the best value. All specialty pharmacy prior authorization requirements will still apply and are the responsibility of the ordering provider. 1-800-822-2761 Anthem ( NYSE: ANTM ) is one of the largest managed care organizations in the United States. Monday through Friday. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. It looks like you're in . Box 312599 Vision and hearing providers: 1-800-482-4047. Box 32593 We created these videos to offer you best practices for helping your patients remain adherent to their medication therapies and educate them on the role that statins play. We help you find the lowestprices for the most effectivemedication. The automated system is available anytime. As one of the nation's leading health plans, Anthem serves millions of members in state-sponsored programs across the nation. View our map (PDF). 8 a.m. to 5 p.m. Say "fax or email" to receive a copy of your claim's status. 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, An Important Message for Members receiving care from Advanced Infusion Solutions (AIS). If you have questions, please contact your group administrator or your Anthem network representative. See what specialty pharmacies are considered in-network. 1-844-876-7917 If you don't have an account yet, you can check claims for BCBSM patients with our automated system. We use Availity Essentials as our provider portal. View listings below of the retail pharmacies that participate in our pharmacy networks. 1-800-482-5982 8 a.m. to 7 p.m. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Just keep in mind you'll need to go through the prompts before you're connected to someone. 20500 Civic Center Drive Facility and Special Programs L07B The automated system is available anytime. The list of specialty pharmacy medications subject to the above will be posted on anthem.com for reference and is subject to change. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). London, KY 40742. 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. Anthem is a registered trademark of Anthem Insurance Companies, Inc. 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. 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. You can also visit. If a medication is selected that is not on the drug list, the member will be responsible for the full cost of the drug. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. P.O. Members have one vendor, one contact, and one ID card. Grand Rapids, MI 49523-0589, Provider Inquiry Grand Rapids, MI 49516-8710, BCN Advantage Claims For the Rx Choice and Base Networks, you can also find Retail 90 and Rx Maintenance 90 pharmacies where you can obtain up to a 90-day supply of your medicine, including CVS. Find yours in our list ofphysician organization consultants (PDF). Not sure which region you're in? Use of the Anthem Web sites constitutes your agreement with our Terms of Use. London, KY 40742. Search for brand and generic medications by condition, or download the CVS Specialty drug list as a PDF (PDF). If specialty medications are obtained through other pharmacies, the claim will be denied. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Compare plans available in your area and apply today. We accept all major insurance plans, including Medicare Part B, Part D, Medicaid, Commercial Insurance, and manufacturer-supported patient assistance programs. The resources for our providers may differ between states. 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. Medication is often one of them. Providing care for those who need it most requires a team effort. Choose your location to get started. 1-800-762-2382 Physicians and professionals: 1-800-344-8525 If you have Rx Maintenance 90 and use CVS, you can get a 90-day supply of any covered drug and pay your home delivery rate. Or The Availity Portal offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer. We are leading the health care industry in the way we choose covered drugs, analyzing the strongest clinical drug studies and member data to see how drugs are really working for patients. Federal Employee Program providers and facilities: 1-800-840-4505. 232 S Capitol Ave We offer affordable health, dental, and vision coverage to fit your budget. Make your mental health a priority. The National Network varies by state and may apply if you get your health insurance plan from an employer, if you purchase your coverage yourself, or if you have certain grandfathered plans. This will have no impact on how members obtain non-specialty pharmacy medications at retail pharmacies or by mail-order. 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. P.O. Providers who are not Designated SRx Network providers will be required to acquire the select specialty pharmacy medications administered in the office or the hospital outpatient setting through CVS Specialty Pharmacy. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Blue Vision providers submit claims electronically directly toVSP. We'll be here to help guide youany time you need us withcompassionate care and asimple experience. Automated information is available anytime. The resources for our providers may differ between states. In Maine: Anthem Health Plans of Maine, Inc. You can count on our guidance, education, and compassion throughout your entire course of treatment. Say "another contract" to inquire on another contract. Get access to your agent portal.Register Now. In Connecticut: Anthem Health Plans, Inc. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. AINPEC-2262-19 October 2019 Specialty Drug List Level 1: You can get prescriptions filled at Level 1 pharmacies for the same copay or percentage of the drug costs you usually pay as part of your prescription drug plan. You'll need to use e-referral for Medicare Plus Blue authorization requests. Call Member Services at
The resources for our providers may differ between states. Register Now, Not registered? 8 a.m. to noon and 1 to 5 p.m. Specialty pharmacies have highly trained pharmacists and nurses to provide personal care and guidance to help you manage your condition. Contact customer service, Heritage Provider service: 1-800-252-2053. 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. 711. You can find yours by selecting your region: Not sure which region you're in? If you are interested in participating in the Designated SRx Network, please contact your provider contracting representative for more details. The Prior Authorization process allows for the request and approval of these medications. 415 S. McClellan Ave. The resources for our providers may differ between states. CVS Specialty makes living with your condition easier. Physicians and professionals: 1-800-344-8525 ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. It can also send you a copy of your claim's status. Box 33248 You can also visit. Monday through Friday. Products & Programs / Pharmacy. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Just keep in mind you'll need to go through the prompts before you're connected to someone. For dates of services on or after July 1, 2020, providers will be required to contact CVS Specialtys dedicated Anthem line listed below to order specialty medications for Medicaid HMO members. If you need more information, you can transfer to a customer service representative during business hours. Whether you need advice from a pharmacist or training on injection techniques, our around-the-clock specialists are available via live chat now. 8 a.m. to noon and 1 to 5 p.m. Mar 10, 2023 05:00pm. We look at our members holistically; offering coordinated medical and pharmacy benefits to help close gaps in care and improve members overall heath. Note:It can take up to 30 days for a claim to be processed. You get your health insurance plan from an employer or if you have certain grandfathered plans. 1-800-762-2382 8:30 a.m. to 6 p.m. Monday through Friday. Our automated interactive voice response system provides claims, benefit and cost-share information. Search for specific text by using your Find function (Ctrl+F or Command+F). We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. The resources on this page are specific to your state. 8:30 a.m. to 4:30 p.m. You can count on our guidance, education, and compassion throughout your entire course of treatment. Access your member ID card from our website or mobile app. Register Now, Learn more about registering for our web tools. Federal Employee Program providers and facilities: 1-800-482-3600 Contact will be made by an insurance agent or insurance company. Your online account is a powerful tool for managing every aspect of your health insurance plan. If you're notanEssential Vision provider, send claims to: Heritage Vision Plans, Inc. You can write to us by finding your ZIP code with the relevant mailing address. Box 7355 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). In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Health equity means that everyone has the chance to be their healthiest. * CVS Specialty is an independent company providing specialty pharmacy services on behalf of Anthem. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. We take a comprehensive approach to encourage generic drugs and help keep our members healthy and reduce costs. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Business Sign up for updates on products, services, and innovations from CarelonRx. Specialty Pharmacy Benefits | Anthem Blue Cross Blue Shield Nevada Medicaid Specialty Pharmacy Extra care to manage your condition Specialty pharmacies are different. Step 4: Say "yes" when asked if you have additional questions about the determination of the claim. Blue Cross Blue Shield of Michigan IngenioRx* is the pharmacy benefits manager. Monday through Friday. Gaps-in-care messaging for our clinical and cost-of-care programs is included in one communication. If your state isn't listed, check out bcbs.com to find coverage in your area. Search for specific text by using your Find function (Ctrl+F or Command+F). Southfield, MI 48075. x][s8~OUS6M/U[[{cgv2n\HCcIlt ^/NgO_M{{tX>]|Y['D;fcIG_aQ Click on the link below to open the pharmacy directory PDF file, which will allow you to find a pharmacy by name, city, state, county, or ZIP code. Step 4: Say "no" when asked if you have additional questions about the determination of a claim. Say "representative" to reach someone who can help. Find a Medicare plan that fits your healthcare needs and your budget. 4 0 obj
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Our electronic prior authorization (ePA) process is the preferred method for submitting pharmacy prior authorization requests. %
Medicaid renewals are starting. This applies to all Anthem Indiana commercial members. Box 2227 Just keep in mind you'll need to go through the prompts before you're connected to someone. 8:30 a.m. to noon and 1 to 5 p.m. You can find yours by selecting your region below. Marquette, MI 49855, Employee Inquiry Get access to your employer portal. You can also talk to your provider consultant. Box 230589 Explore our comprehensive guides and video resources for more information regarding your condition. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Our Patient Highlights communication is focused on controlled substance care opportunities, including the identification of members receiving multiple controlled substance medications, high-dose opioids or opioids from multiple providers and filled at multiple pharmacies, or combinations of controlled substances that may indicate risk. Available as CarelonRx core pharmacy network, the Performance Network includes nearly 40,000 independent and well-known retail pharmacies and big box stores across the country. We offer flexible group insurance plans for any size business. Step 2:Answer the system's prompts about your patient and whether you provided care in Michigan. Price a medication, find a pharmacy,order auto refills, and more. Clients have one vendor, one contact, one contract, one eligibility feed, and one invoice. You can write to us by matching your area code with the relevant mailing address. The automated system is available anytime. Log in to your account to manage your specialty prescriptions. Jan 1, 2021 We look forward to working with you to provide quality service for our members. The Base Network is our national pharmacy network and includes nearly 70,000 retail pharmacies across the country. Get access to your online account. Our goal is to help improve your patients' health outcomes by combining medical, pharmacy and lab data ensuring coordination of our people, programs and . Detroit, MI 48226. Choose your state below so that we can provide you with the most relevant information. To comply with Anthems programs related to the management of pharmacy expenses, providers will be required to obtain specialty pharmacy medications administered in the office or outpatient hospital setting through CVS Specialty effective July 1, 2020. P.O. 8 a.m. to noon and 1 to 5 p.m. Grand Rapids, MI 49516-8753, Blue Cross Complete Claims You can write to us by finding your area code with the relevant mailing address. 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. 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 use drug lists, along with gaps-in-care messaging, to support overall member health. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? Log in at availity.com. If you no longer qualify, we can connect you to the right options for you and your family. Submit prior authorization requestselectronicallythrough CoverMyMeds. 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. The notice states that the requirement applies to Anthem's commercial HMO effective with July 1, 2020, dates of service . Not registered? Pay outstanding doctor bills and track online or in-person payments. Detroit, MI 48321-2227, Blue Cross Blue Shield of Michigan 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. Manage your medicine from anywhere with the Sydney Health mobile app With the free app, you can: Explore programs available in your state. Members should talk with their doctor about prescribing a drug that is on the drug list. Blue Cross Blue Shield of Michigan In Kentucky: Anthem Health Plans of Kentucky, Inc. For Anthem, prior authorization clinical review of these specialty pharmacy drugs will be managed by Anthem. Start a Live Chat with one of our knowledgeable representatives. 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. This allows us to send generic and therapeutic equivalent messages with member-specific cost savings. Check ereferrals.bcbsm.com for detailed prior authorization information. If you're a provider who needs to contact us about one of our Blue Cross Blue Shield of Michigan, Blue Care Network or our Medicare products, start here. Monday through Friday, Care Management--Mail Code C355 Box 7355 Customer service is available 8 a.m. to noon and 1 p.m. to 5 p.m. Monday through Friday. 3 0 obj
A group of doctors and pharmacists from outside our organization lead the selection of drugs included in our drug lists. When you're contracted with us you have access to a provider consultant. Say "claims" when the system asks why you're calling. Get access to your agent portal. For a step-by-step guide to Electronic Data Interchange, also known as EDI, read our FAQ on the topic. After a warning period to correct behavior, members become restricted to one pharmacy, designated as the home pharmacy. A partnership with our providers will enhance this programs ability to reduce the risk of opioid misuse and enable earlier identification of members facing substance use-related conditions. Pharmacy benefits Anthem Blue Cross and Blue Shield will administer pharmacy benefits for members enrolled in Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect. Provider Inquiry Mail Code 0301 1-800-344-8525 Your browser is not supported. Step 2: Answer the prompts about your patient and whether you provided care in Michigan. Say "no" when asked if you have additional questions about the determination of a claim. Box 68710 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. 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. Please call Accredo at 1-844-433-4878 or visit submittal. CVS Specialty will bill us, and we will pay them directly. Specialty Pharmacy Benefits | Anthem BlueCross BlueShield Kentucky Medicaid Specialty Pharmacy Extra care to manage your condition Specialty pharmacies are different. When you write the new prescription, you can fax or efax the form and prescription to the phone number on the form. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. Understand your care options ahead of time so you can save time and money. If you need additional guidance, read the Dentaquest Dental Manual (PDF). 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. Mailing address for medical records for authorizations, Essential Vision providerssubmit claims through. 1 0 obj
Medicare Complaints, Grievances & Appeals. 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. You can order by phone whether or not you're already a member. ??9h/dWn&}oS!LK$= -WY9#\3Lx]nO$~eRN s r^>}\;"YEL7%bl q!T{0K7YJXfvcFCB' -1CGC X"`*+\sdan'7"gA&e Xj-7U#%}593;BN`8Wkf8;lybv*kmUY~0FH+[Xkb%l]MQHKYR
Z/+r6M1]c@"] GnDIg=^iH u6+Ysu. 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. 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. 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.
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