Mar 10, 2023 05:00pm. New member? Blue Cross Blue Shield of Michigan Use e-referral for authorizations for Blue Care Network and BCN AdvantageSM members. 8 a.m. to noon and 1 to 5 p.m. Medication is often one of them. Monday through Friday. If you don't have an account yet, you can check claims for BCBSM patients with our automated system. endobj If a medication is selected that is not on the drug list, the member will be responsible for the full cost of the drug. Box 68710 CVS Health ( NYSE: CVS ) is a coast-to-coast healthcare conglomerate comprised of retail / mail order. You get your health insurance plan from an employer or if you have certain grandfathered plans. Step 4: Say "no" when asked if you have additional questions about the determination of a claim. Contact will be made by an insurance agent or insurance company. Explore our resources. Search for specific text by using your Find function (Ctrl+F or Command+F). Compare plans available in your area and apply today. If specialty medications are obtained through other pharmacies, the claim will be denied. For help with AcariaHealth, call 1-800-511-5144 (TTY 1-800-955-8770), Monday through Friday, 8:00 a.m. to 10:00 p.m., Eastern time. 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). Please call Accredo at 1-844-433-4878 or visit Independent licensees of the Blue Cross and Blue Shield Association. 1-800-482-4047 Blue Cross Blue Shield of Michigan It can also send you a copy of your claim's status. Medical and pharmacy strategies complement each other; theyre based on the same goals. Find out if your medication is available through CVS Specialty. Box 2227 These pharmacies serve members with complex or chronic conditions. Monday through Friday. 8 a.m. to 7 p.m. Grand Rapids, MI 49516-8753, Blue Cross Complete Claims Please update your browser if the service fails to run our website. Our goal is to help improve your patients' health outcomes by combining medical, pharmacy and lab data ensuring coordination of our people, programs and . We also offer infusion services with Optum Infusion Pharmacy. Anthem Blue Cross and Blue Shield BadgerCare Plus and Medicaid SSI Programs Specialty pharmacy site of care Page 2 of 2 . Our resources vary by state. Your dashboard may experience future loading problems if not resolved. Note:It can take up to 30 days for a claim to be processed. Say "fax or email" to receive a copy of your claim's status. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. Monday through Friday, Care Management--Mail Code C355 The Blue Cross name and symbol are registered marks of the Blue Cross Association. Specialty pharmacies are different. 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. Southfield, MI 48075, 1-877-293-2788 The automated system is available anytime. Find answers to all your questions with an Anthem representative in real time. Blue Cross Blue Shield of Michigan 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. 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. You purchased a plan on your state or federal Health Insurance Marketplace (also known as the exchange), You purchased coverage off the exchange and not through your employer, Your coverage is through a Small Group employer on, and in some cases, off the exchange. Medical Prior Authorization requests can be submitted through CoverMyMeds. Say "another member" to inquire on another member. The automated system is available anytime. Automated information is available anytime. Drugs used for the treatment of Oncology will still require pre-service clinical review by AIM. x][s8~OUS6M/U[[{cgv2n\HCcIlt ^/NgO_M{{tX>]|Y['D;fcIG_aQ Refill and track your specialty drug prescriptions, pay online, and get live support. 20500 Civic Center Drive In Kentucky: Anthem Health Plans of Kentucky, Inc. Monday through Friday Just keep in mind you'll need to go through the prompts before you're connected to someone. We look forward to working with you to provide quality service for our members. Understand your care options ahead of time so you can save time and money. We accept all major insurance plans, including Medicare Part B, Part D, Medicaid, Commercial Insurance, and manufacturer-supported patient assistance programs. We see how drugs work in our members real lives and help them make good health care choices. There's no more critical person on this team than you, the provider. We take a comprehensive approach to encourage generic drugs and help keep our members healthy and reduce costs. IngenioRx Specialty Pharmacy provides your specialty medications. View our map (PDF). Hospitals or facilities: 1-800-249-5103. 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. The automated system is available anytime. We look forward to working with you to provide quality service for our members. You can: Call Specialty Pharmacy Member Services at 1-833-255-0646 (TTY 711) anytime day or night to speak with your Care Team. Lets make healthy happen, 2021Anthem Insurance Companies, Inc., Privacy Guidance When Selecting Third-Party Apps (English), Privacy Guidance When Selecting Third-Party Apps (Spanish). 1 0 obj Your dashboard may experience future loading problems if not resolved. Use our app, Sydney Health, to start a Live Chat. New member? Don't have a secured provider portal account yet? Review medical and pharmacy benefits for up to three years. Monday through Friday, 1-800-431-1059 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. You can also visit. Not sure which region you're in? If you no longer qualify, we can connect you to the right options for you and your family. 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. Monday through Friday The resources for our providers may differ between states. 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. 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 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. Both medical and pharmacy costs are our responsibility. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. This allows us to send generic and therapeutic equivalent messages with member-specific cost savings. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Hospitals or facilities: 1-800-249-5103 Blue Cross Blue Shield of Michigan. 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. 8:30 a.m. to noon and 1 to 5 p.m. Mailing address for medical records for authorizations, Essential Vision providerssubmit claims through. The Rx Choice Tiered Network may not be available in all states. CVS Specialty Pharmacy is an Anthem Blue Cross (Anthem) designated provider of certain specialty medications administered in the office or outpatient hospital setting. Say "claims" when the system asks why you're calling. Monday through Friday <>>> P.O. 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. Get translation and interpretation services free of charge. Step 6:Tell the system the total amount charged. Virginia Anthem HealthKeepers Plus plan offered by HealthKeepers, Inc. Wisconsin Anthem Blue Cross and Blue Shield. Scroll down and select Pharmacy in the Category drop down. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. Monday through Friday Business Sign up for updates on products, services, and innovations from CarelonRx. Customer service is available 8 a.m. to noon and 1 p.m. to 5 p.m. Monday through Friday. 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. Physicians and professionals: 1-800-344-8525 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. Providers who are Designated SRx Network providers can continue to acquire and administer the specialty pharmacy medications covered under the members medical benefit plan. P.O. There's no more critical person on this team than you, the provider. Federal Employees Program We currently don't offer resources in your area, but you can select an option below to see information for that state. Log in to your account to manage your specialty prescriptions. 1-800-249-5103 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. Individuals attempting unauthorized access will be prosecuted. Not registered? To report fraud, waste or abuse, call our hotline: 1-800-437-3803 CVS Specialty makes living with your condition easier. All you need to know about the COVID-19 vaccines and boosters.Get the details. A specialty pharmacy does more than just fill prescriptions. Just keep in mind you'll need to go through the prompts before you're connected to someone. Find yours in our list ofphysician organization consultants (PDF). stream 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. Get access to your agent portal. To access the current Designated Medical Specialty Pharmacy Drug List, visit anthem.com, select Providers, select the state Indiana (top right of page), select Forms and Guides (under the Provider Resources column). This applies to all Anthem Indiana commercial members. The resources for our providers may differ between states. Step 5: Tell the system the date of service provided. If you need more information, you can transfer to a customer service representative during business hours. If youre a professional provider office, you have access to a provider consultant. Detroit, MI 48321-2227, Blue Cross Blue Shield of Michigan 1-844-396-2329 (TTY 711). Blue Cross Blue Shield of Michigan 1-888-826-8152 2 0 obj Register Now, Not registered? Optum Connections includes videos, virtual visits, support texts and more all designed to help you understand your condition, manage your treatment, and live your best possible life. The Availity Portal offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer. Vision providers who can't access their account or need more information can read the Blue Vision Provider Summary Guide (PDF) to learn how to: Submit claims, appeals and attachments As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. 4 0 obj And to help ensure coordination of care and compliance, physicians also receive a consolidated communication with similar messages. 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. If you're notanEssential Vision provider, send claims to: Heritage Vision Plans, Inc. Step 5:Tell the system the date of service provided. 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. 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. 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. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. P.O. Manage your medicine from anywhere with the Anthem mobile app With the free app, you can: Order refills Track orders View all prescriptions Download the app now: Page Last Updated: 06/09/21 Everything we do centers ongetting you the prescriptionyou need, when you need it,your way. Box 68753 Providers should continue to submit for administration of the medication, but not bill for the medication itself. Our automated interactive voice response system provides claims, benefit and cost-share information. Large Group 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. Southfield, MI 48075. Register Now, Not registered? 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. 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. TTY users: To reach any number listed here, dial 711. Anthem ( NYSE: ANTM ) is one of the largest managed care organizations in the United States. In Ohio: Community Insurance Company. We currently don't offer resources in your area, but you can select an option below to see information for that state. ??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. By using targeted, concise communication, we help members make good health care choices and improve health outcomes. 2005 - 2022 copyright of Anthem Insurance Companies, Inc. Step 2 - In "Patient Information", provide the patient's full name, phone number, full address, date of birth, sex (m/f), height, and weight. P.O. In Connecticut: Anthem Health Plans, Inc. Step 5: Tell the system the date of service. Say "date of service" to learn about a different claim. 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. It can also send you a copy of your claim's status. Monday through Friday. Providers may continue to submit a claim for administration of the specialty pharmacy medications, which will be reimbursed at the current contracted rates. P.O. 8:30 a.m. to 4:30 p.m. CarelonRx is the pharmacy benefits manager (PBM) for Anthem HealthKeepers Plus members in Virginia. 1-877-258-0167 Dental providers should log in to their secured portal to contact someone for questions about care, payment and claims. Medicare Complaints, Grievances & Appeals. 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. You can also visit bcbs.com to find resources for other states. It looks like you're in . L07B 232 S Capitol Ave You can also use these documents for guidance: Have your NPI, Tax ID or Social Security number ready before calling. 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 Base Network is our national pharmacy network and includes nearly 70,000 retail pharmacies across the country. 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. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. We look at claims data to find opportunities for our members to save money by switching them to lower-cost, therapeutically equivalent drugs. 42I]?evMJz8q9|eszwdZL9}owq1}s&,/K{IP,xW^.` Monday through Friday Federal Employee Program providers and facilities: 1-800-840-4505. Providing care for those who need it most requires a team effort. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? What you need to know about the coronavirus, COVID-19. London, KY 40742. You'll need to use e-referral for Medicare Plus Blue authorization requests. Physicians and professionals: 1-800-344-8525 Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. The Prior Authorization process allows for the request and approval of these medications. Step 7: Listen to your claim's status, which includes the following information: Say "same member" to inquire on another member. 1-800-344-8525 8 a.m. to 4 p.m. 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. Automated information is available anytime. Specialty Pharmacy Benefits | Anthem BlueCross BlueShield Kentucky Medicaid Specialty Pharmacy Extra care to manage your condition Specialty pharmacies are different. If you're interested in joining the Physician Group Incentive Program, also known as PGIP, or want more information, emailvaluepartnerships@bcbsm.com. It looks like you're in . Get access to your employer portal. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. We offer affordable health, dental, and vision coverage to fit your budget. 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're already a member, you can email us at DirectoryRequest_MMP@anthem.com to ask for a printed Drug List. 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. You can write to us by finding your ZIP code with the relevant mailing address. Important informationabout your 1095-B form. Jan 1, 2021 You can count on our guidance, education, and compassion throughout your entire course of treatment. P.O. 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. 711. Blue Cross Blue Shield of Michigan Provider Inquiry Mail Code 0301 8:30 a.m. to 6 p.m. Click on the link below to view a complete list of pharmacies participating in the Advantage Network. Facility and Special Programs 8 a.m. to noon and 1 to 5 p.m. Here to Help You. Say "another contract" to inquire on another contract. Posted 10:46:35 PM. 1-855-504-2583 Members dont receive multiple letters focused on individual clinical and cost-of-care programs. 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. 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. 1-800-482-5982 We currently don't offer resources in your area, but you can select an option below to see information for that state. Creating an account is free, easy and helps patients get their medications sooner. In Indiana: Anthem Insurance Companies, Inc. 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. P.O. 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. CVS Specialty dispenses a wide array of specialty medication used to treat many health conditions. Our drug lists allow members and their doctors to choose from a wide variety of prescription drugs. You can write to us by matching your area code with the relevant mailing address. Your browser is not supported. 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. For a step-by-step guide to Electronic Data Interchange, also known as EDI, read our FAQ on the topic. You can write to us by finding your area code with the relevant mailing address. 1-888-803-4960 Our medical and pharmacy experts work collaboratively. HealthKeepers, Inc. administers its pharmacy benefit and establishes prior authorization requirements in accordance with all applicable state and federal laws and regulations. Register Now, Learn more about registering for our web tools. Providers who don't have an account yet can mail a claim to one of the following: Blue Care Network Claims 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. Marquette, MI 49855, Employee Inquiry Box 32593 Attention: Claim Processing We encourage medications that improve patient health. All specialty pharmacy prior authorization requirements will still apply and are the responsibility of the ordering provider. In Maine: Anthem Health Plans of Maine, Inc. Preferred Drug List and Formulary Search You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. We look at our members holistically; offering coordinated medical and pharmacy benefits to help close gaps in care and improve members overall heath. 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. Call our Customer Service number, (TTY: 711). endobj There is no cost for this service. If you are interested in participating in the Designated SRx Network, please contact your provider contracting representative for more details. Some drugs, and certain quantities of some drugs, require an approval before they are eligible for coverage. 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. Step 6: You will then be transferred to the servicing center for assistance. For questions about the determination of a claim to be processed for a claim also... For you and your family Plus and Medicaid SSI Programs specialty pharmacy covered! All applicable state and federal laws and regulations medications are obtained through other pharmacies, the claim will be.. Plus Blue authorization requests their secured portal to contact someone for questions about care, payment and claims portal healthcare. 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