CVS Specialty makes living with your condition easier. 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. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Members have one vendor, one contact, and one ID card. We offer home delivery, as well as Retail 90 and Smart 90 pharmacy networks as options for members to fill up to a 90-day supply of their medications. Box 230589 Providers who are Designated SRx Network providers can continue to acquire and administer the specialty pharmacy medications covered under the members medical benefit plan. 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 write to us by matching your area code with the relevant mailing address. 8 a.m. to noon and 1 to 5 p.m. We currently don't offer resources in your area, but you can select an option below to see information for that state. If a medication is selected that is not on the drug list, the member will be responsible for the full cost of the drug. 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. The resources for our providers may differ between states. 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. Access your member ID card from our website or mobile app. 1-800-249-5103 Medicare Complaints, Grievances & Appeals. Just keep in mind you'll need to go through the prompts before you're connected to someone. Automated information is available anytime. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. There's no more critical person on this team than you, the provider. Grand Rapids, MI 49516-8710, BCN Advantage Claims New Directions. If you no longer qualify, we can connect you to the right options for you and your family. Learn more. P.O. Jun 1, 2020 2005 - 2022 copyright of Anthem Insurance Companies, Inc. 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. 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. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. In Ohio: Community Insurance Company. 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. These pharmacies serve members with complex or chronic conditions. 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. Contact customer service, Heritage Provider service: 1-800-252-2053. Get access to your online account.Register Now, Not registered? Available for iOS and Android devices. Creating an account is free, easy and helps patients get their medications sooner. We use Availity Essentials as our provider portal. 1-888-826-8152 1-844-876-7917 endobj What you need to know about the coronavirus, COVID-19. Our resources vary by state. Register Now, Not registered? ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Step 4: Say "no" when asked if you have additional questions about the determination of a claim. Our automated interactive voice response system provides claims, benefit and cost-share information. Automated information is available anytime. Log in to your account to manage your specialty prescriptions. Choose your state below so that we can provide you with the most relevant information. If you call before 30 days, we may not be able to check your claim through our automated phone system. Clients have one vendor, one contact, one contract, one eligibility feed, and one invoice. P.O. Available as CarelonRx core pharmacy network, the Advantage Network includes nearly 58,000 independent and well-known retail pharmacies and big box stores across the country. 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. 8:30 a.m. to noon and 1 to 5 p.m. All you need to know about the COVID-19 vaccines and boosters.Get the details. Customer service is available 8 a.m. to noon and 1 p.m. to 5 p.m. Monday through Friday. When you write the new prescription, you can fax or efax the form and prescription to the phone number on the form. Birmingham, AL 35238-0518. Effective for dates of service March 1, 2022, and beyond, requests for the medications listed above and the clinical information submitted will be reviewed for both medical necessity of the medication itself (as is done Ascension reports 2.9% operating margin in H1 2023, says improvement plan is beginning to make headway. Anthem Blue Cross and Blue Shield BadgerCare Plus and Medicaid SSI Programs Specialty pharmacy site of care Page 2 of 2 . 8 a.m. to noon and 1 to 5 p.m. If your state isn't listed, check out bcbs.com to find coverage in your area. Box 32593 As one of the nation's leading health plans, Anthem serves millions of members in state-sponsored programs across the nation. Search for specific text by using your Find function (Ctrl+F or Command+F). Attention: Claim Processing Use e-referral for authorizations for Blue Care Network and BCN AdvantageSM members. Monday through Friday. You can also visit. 1-800-344-8525 We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. 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. You can: Call Specialty Pharmacy Member Services at 1-833-255-0646 (TTY 711) anytime day or night to speak with your Care Team. P.O. Members should talk with their doctor about prescribing a drug that is on the drug list. Use our app, Sydney Health, to start a Live Chat. If you have questions, please contact your group administrator or your Anthem network representative. Monday through Friday Blue Vision providers submit claims electronically directly toVSP. 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. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. 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. 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). 711. This will have no impact on how members obtain non-specialty pharmacy medications at retail pharmacies or by mail-order. Detroit, MI 48231-0166, Federal Employee Program claims 8:30 a.m. to 4:30 p.m. Providers should continue to submit for administration of the medication, but not bill for the medication itself. 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. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. You get your health insurance plan from an employer or if you have certain grandfathered plans. Say "claims" when the system asks why you're calling. View our map (PDF). 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. Get access to your agent portal.Register Now. Medical Prior Authorization requests can be submitted through CoverMyMeds. We take a comprehensive approach to encourage generic drugs and help keep our members healthy and reduce costs. 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. Get access to your online account. Monday through Friday We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Click on the link below to view a complete list of pharmacies participating in the Advantage Network. We offer flexible group insurance plans for any size business. Vision and hearing providers: 1-800-482-4047 These pharmacies serve members with complex or chronic conditions. Specialty Pharmacy Benefits | Anthem BlueCross BlueShield Kentucky Medicaid Specialty Pharmacy Extra care to manage your condition Specialty pharmacies are different. Click on the link below to view a complete list of pharmacies participating in the Performance Network. Look for these symbols in the pharmacy listings: Pharmacy search tips: 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 If you're already a member, you can email us at DirectoryRequest_MMP@anthem.com to ask for a printed Drug List. The Pharmacy Home Program identifies members who may be over-utilizing providers, medications and pharmacies to obtain controlled substances. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. If you don't have an account yet, you can check claims for with our automated system. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. You'll need to use e-referral for Medicare Plus Blue authorization requests. Please update your browser if the service fails to run our website. The resources on this page are specific to your state. The list of specialty pharmacy medications subject to the above will be posted on anthem.com for reference and is subject to change. 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. By using targeted, concise communication, we help members make good health care choices and improve health outcomes. Providers who don't have an account can mail a claim to one of the following: Medicare Plus BlueSM PPO claims Find a Medicare plan that fits your healthcare needs and your budget. Vision and hearing providers: 1-800-482-4047. Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Say "another member" to inquire on another member. 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. 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. 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. 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. Verify patient eligibility and benefits Your dashboard may experience future loading problems if not resolved. 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. Note: The FEP phone system has a different set of prompts than the others. Monday through Friday, Care Management--Mail Code C355 8 a.m. to 6 p.m. 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. Providers who don't have an account yet can mail a claim to one of the following: Blue Care Network Claims There, you can log in to refill, manage, and sign up for home delivery. Drugs used for the treatment of Oncology will still require pre-service clinical review by AIM. 2 0 obj We currently don't offer resources in your area, but you can select an option below to see information for that state. London, KY 40742. 8 a.m. to 5 p.m. 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. Facility and Special Programs HealthKeepers, Inc. administers its pharmacy benefit and establishes prior authorization requirements in accordance with all applicable state and federal laws and regulations. The failure to do so may result in claim denials and the member cannot be billed for these specialty medications. Detroit, MI 48226. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Our drug lists allow members and their doctors to choose from a wide variety of prescription drugs. If you don't have an account yet, you can check claims for BCBSM patients with our automated system. In Maine: Anthem Health Plans of Maine, Inc. Monday through Friday. We currently don't offer resources in your area, but you can select an option below to see information for that state. 232 S Capitol Ave Scroll down and select Pharmacy in the Category drop down. Blue Cross Blue Shield of Michigan 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. Use of the Anthem Web sites constitutes your agreement with our Terms of Use. Refill and track your specialty drug prescriptions, pay online, and get live support. Please update your browser if the service fails to run our website. 1-855-504-2583 That state Anthem insurance Companies, Inc members make good health care choices and health... 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