Step 6: Tell the system the total amount charged. The purpose of this communication is the solicitation of insurance. We also offer infusion services with Optum Infusion Pharmacy. Make your mental health a priority. Please update your browser if the service fails to run our website. endobj If you don't have an account yet, you can check claims for with our automated system. 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. Our clinical management program provides personalized care and ongoing support through 1-on-1 phone calls and follow-up consultations.Learn more. CVS Specialty helps patients with complex conditions manage their medications and live their best lives. Please update your browser if the service fails to run our website. Box 230589 Virginia Anthem HealthKeepers Plus plan offered by HealthKeepers, Inc. Wisconsin Anthem Blue Cross and Blue Shield. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? 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. * CVS Specialty is an independent company providing specialty pharmacy services on behalf of Anthem. Register Now, Not registered? Not sure which region you're in? Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. To stay covered, Medicaid members will need to take action. Specialty pharmacies have highly trained pharmacists and nurses to provide personal care and guidance to help you manage your condition. 8:30 a.m. to noon and 1 to 5 p.m. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Medicaid renewals are starting. 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. Get access to your employer portal. You can: Call Specialty Pharmacy Member Services at 1-833-255-0646 (TTY 711) anytime day or night to speak with your Care Team. In Connecticut: Anthem Health Plans, Inc. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Monday through Friday 711. Step 5: Tell the system the date of service provided. 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. Lansing, MI 48933. You can write to us by finding your ZIP code with the relevant mailing address. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Just keep in mind you'll need to go through the prompts before you're connected to someone. We use Availity Essentials as our provider portal. Use New Directions' WebPass tool. It looks like you're in . Box 68710 In Indiana: Anthem Insurance Companies, Inc. endobj Business Sign up for updates on products, services, and innovations from CarelonRx. There, you can log in to refill, manage, and sign up for home delivery. If you don't have an account yet, you can check claims for BCBSM patients with our automated system. 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. We currently don't offer resources in your area, but you can select an option below to see information for that state. As one of the nation's leading health plans, Anthem serves millions of members in state-sponsored programs across the nation. 1-855-504-2583 A specialty pharmacy does more than just fill prescriptions. There's no more critical person on this team than you, the provider. 8 a.m. to noon and 1 to 5 p.m. Vision and hearing providers: 1-800-482-4047. Compare plans available in your area and apply today. We help you find the lowestprices for the most effectivemedication. Box 7355 Automated information is available anytime. You can count on our guidance, education, and compassion throughout your entire course of treatment. Box 310166 Specialty pharmacies are different. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. P.O. Call our Customer Service number, (TTY: 711). Whether you need advice from a pharmacist or training on injection techniques, our around-the-clock specialists are available via live chat now. Use of the Anthem websites constitutes your agreement with our Terms of Use. 3 0 obj L07B 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. Your online account is a powerful tool for managing every aspect of your health insurance plan. You can also use these documents for guidance: Have your NPI, Tax ID or Social Security number ready before calling. Verify patient eligibility and benefits We look at how drugs work in the real lives of our members, then use our medical and pharmacy data and analyze claims analysis to make sure the medications really work. The Prior Authorization process allows for the request and approval of these medications. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. 1-877-258-0167 We provide health insurance in Michigan. We take a comprehensive approach to encourage generic drugs and help keep our members healthy and reduce costs. P.O. 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. Monday through Friday, 1-800-431-1059 If specialty medications are obtained through other pharmacies, the claim will be denied. 1-800-762-2382 We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. It can also send you a copy of your claim's status. We offer flexible group insurance plans for any size business. Medical and pharmacy strategies complement each other; theyre based on the same goals. We offer affordable health, dental, and vision coverage to fit your budget. 2 0 obj 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. This applies to all Anthem Indiana commercial members. We look at our members holistically; offering coordinated medical and pharmacy benefits to help close gaps in care and improve members overall heath. Some drugs, and certain quantities of some drugs, require an approval before they are eligible for coverage. Explore our resources. Box 312599 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 interested in joining the Physician Group Incentive Program, also known as PGIP, or want more information, emailvaluepartnerships@bcbsm.com. 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. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. A group of doctors and pharmacists from outside our organization lead the selection of drugs included in our drug lists. 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. Physicians and professionals: 1-800-344-8525 Our resources vary by state. 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. 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. You can find yours by selecting your region: Not sure which region you're in? Plus, you may qualify for financial help to lower your health coverage costs. If you misplace your medicine or it is stolen, contact your provider. Specialty Pharmacy Benefits | Anthem Blue Cross Blue Shield Nevada Medicaid Specialty Pharmacy Extra care to manage your condition Specialty pharmacies are different. Attention: Claim Processing Manage your medicine from anywhere with the Sydney Health mobile app With the free app, you can: Not connected with or endorsed by the U.S. Government or the federal Medicare program. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Choose your location to get started. Automated information is available anytime. Mailing address for medical records for authorizations, Essential Vision providerssubmit claims through. The resources for our providers may differ between states. Choose your location to get started. 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. 8:30 a.m. to noon and 1 to 5 p.m. IngenioRx is a separate company that provides pharmacy services and pharmacy benefit management services on behalf of Anthem Blue Cross and Blue Shield. We send members personalized messages about medications that may reduce their costs and include specific cost savings. 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. 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. Featured In: <> The resources for our providers may differ between states. 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 currently don't offer resources in your area, but you can select an option below to see information for that state. Blue Cross Blue Shield of Michigan IngenioRx Specialty Pharmacy provides your specialty medications. It can also send you a copy of your claim's status. Medication is often one of them. 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 What you need to know about the coronavirus, COVID-19. Click on the link below to view a complete list of pharmacies participating in the Performance Network. Contact customer service, Heritage Provider service: 1-800-252-2053. Specialty medications are used to treat these conditions and often require special storage or extra support. 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. Use e-referral for authorizations for Blue Care Network and BCN AdvantageSM members. If you no longer qualify, we can connect you to the right options for you and your family. Box 7355 ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The link below provides the current list of drugs that must be obtained from CVS Specialty Pharmacy or another provider in our designated specialty pharmacy network. Federal Employee Program providers and facilities: 1-800-840-4505. We engage members and you, their doctors. We currently don't offer resources in your area, but you can select an option below to see information for that state. <>>> New member? 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). Choose your state below so that we can provide you with the most relevant information. We look forward to working with you to provide quality service for our members. Say "representative" to reach someone who can help. P.O. AINPEC-2262-19 October 2019 Specialty Drug List Understand your care options ahead of time so you can save time and money. Call Specialty Pharmacy Member Services at 1-833-255-0646 (TTY 711) anytime, day or night to speak with our Care Team. If youre a professional provider office, you have access to a provider consultant. 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. Don't have a secured provider portal account yet? Our goal is to help improve your patients' health outcomes by combining medical, pharmacy and lab data ensuring coordination of our people, programs and . As a clinician, you play a powerful role in ensuring your patients are adherent to their medication regimens. 1-800-822-2761 ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. CVS Specialty will bill us, and we will pay them directly. Find a Participating Pharmacy in Your Area. For costs and complete details of the coverage, please contact your agent or the health plan. Learn more. The Rx Choice Tiered Network may not be available in all states. Detroit, MI 48232-0593, UB-04 claims 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. Step 6:Tell the system the total amount charged. 8 a.m. to noon and 1 to 5 p.m. Call Specialty Pharmacy Member Services at 1-833-255-0646 (TTY 711) anytime, day or night to speak with our Care Team. 8:30 a.m. to 4:30 p.m. 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. Step 1: Say "claims" when the system asks why you're calling. 1-800-482-4047 You can also visit. You can order by phone whether or not you're already a member. Federal Employees Program Step 2 - In "Patient Information", provide the patient's full name, phone number, full address, date of birth, sex (m/f), height, and weight. 1-877-258-0167 Register Now, Learn more about registering for our web tools. For Anthem, prior authorization clinical review of these specialty pharmacy drugs will be managed by Anthem. Medicare Complaints, Grievances & Appeals. When you email us, we'll call . Monday through Friday. 1-800-762-2382 8:30 a.m. to 6 p.m. Monday through Friday. Say "another member" to inquire on another member. We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. Monday through Friday. 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 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. Independent licensees of the Blue Cross and Blue Shield Association. 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. CVS Specialty dispenses a wide array of specialty medication used to treat many health conditions. Step 2: Answer the prompts about your patient and whether you provided care in Michigan. Refill and track your specialty drug prescriptions, pay online, and get live support. 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. New member? 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 5: Tell the system the date of service. Vision and hearing providers: 1-800-482-4047 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. 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. 8:30 a.m. to 6 p.m. 20500 Civic Center Drive 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. All specialty pharmacy prior authorization requirements will still apply and are the responsibility of the ordering provider. Review medical and pharmacy benefits for up to three years. Providing care for those who need it most requires a team effort. Southfield, MI 48075, 1-877-293-2788 x][s8~OUS6M/U[[{cgv2n\HCcIlt ^/NgO_M{{tX>]|Y['D;fcIG_aQ 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. Detroit, MI 48231-2599, Blue Cross Complete claims 8 a.m. to noon and 1 to 5 p.m. Anthem ( NYSE: ANTM ) is one of the largest managed care organizations in the United States. It looks like you're outside the United States. Monday through Friday 8 a.m. to 5 p.m. Lets make healthy happen. Providers who don't have an account yet can mail a claim to one of the following: Blue Care Network Claims We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. If your state isn't listed, check out bcbs.com to find coverage in your area. Your dashboard may experience future loading problems if not resolved. If you're notanEssential Vision provider, send claims to: Heritage Vision Plans, Inc. This allows us to send generic and therapeutic equivalent messages with member-specific cost savings. It looks like you're outside the United States. Blue Vision providers submit claims electronically directly toVSP. To report fraud, waste or abuse, call our hotline: 1-800-437-3803 Provider Inquiry Mail Code 0301 Members should talk with their doctor about prescribing a drug that is on the drug list. Providers who are Designated SRx Network providers can continue to acquire and administer the specialty pharmacy medications covered under the members medical benefit plan. Health equity means that everyone has the chance to be their healthiest. Understand your care options ahead of time so you can save time and money. 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. P.O. One Woodward Avenue, Suite 2020 Detroit, MI 48232-4248, Provider Inquiry A specialty pharmacy does more than just fill prescriptions. Jan 1, 2021 The Pharmacy Home Program identifies members who may be over-utilizing providers, medications and pharmacies to obtain controlled substances. If you need more information, you can transfer to a customer service representative during business hours. 8 a.m. to 7 p.m. 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. 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. 1-800-344-8525 Get access to your agent portal. Find yours in our list ofphysician organization consultants (PDF). In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. %PDF-1.5 Policies are aligned. Monday through Friday. HealthKeepers, Inc. administers its pharmacy benefit and establishes prior authorization requirements in accordance with all applicable state and federal laws and regulations. P.O. 1-844-396-2329 (TTY 711). Your dashboard may experience future loading problems if not resolved. If you have questions or need assistance, we're always here to help. You can also talk to your provider consultant. Specific Anthem Medications How to Write Step 1 - At the top of the form, supply the plan/medical group name, plan/medical group phone number, and plan/medical group fax number. Call Member Services at Grand Rapids, MI 49523-0589, Provider Inquiry CVS Specialty makes living with your condition easier. Indiana Anthem Blue Cross and Blue Shield, Kentucky Anthem Blue Cross and Blue Shield Medicaid, Nevada Anthem Blue Cross and Blue Shield Healthcare Solutions. The automated system is available anytime. This applies to members with Preferred Provider Organization (PPO), HealthKeepers (HMO), POS AdvantageOne, and Act Wise (CDH plans). Search for specific text by using your Find function (Ctrl+F or Command+F). 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). Step 2:Answer the system's prompts about your patient and whether you provided care in Michigan. CarelonRx is the pharmacy benefits manager (PBM) for Anthem HealthKeepers Plus members in Virginia. 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. Providing care for those who need it most requires a team effort. You can write to us by matching your area code with the relevant mailing address. Start a Live Chat with one of our knowledgeable representatives. Get the mobile app Find a Medicare plan that fits your healthcare needs and your budget. The Base Network is our national pharmacy network and includes nearly 70,000 retail pharmacies across the country. 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. Pharmacy Information and Tools. We currently don't offer resources in your area, but you can select an option below to see information for that state. This will have no impact on how members obtain non-specialty pharmacy medications at retail pharmacies or by mail-order. 8:30 a.m. to noon and 1 to 5 p.m. You can find yours by selecting your region below. 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 Availity Portal offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer. Detroit, MI 48231-0166, Federal Employee Program claims Get help with your copays by chatting with a patient care coordinator today. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Products & Programs / Pharmacy. 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. Facility and Special Programs Hospitals or facilities: 1-800-249-5103 8 a.m. to 7 p.m. Our medical and pharmacy experts work collaboratively. The automated system is available anytime. Providers should continue to submit for administration of the medication, but not bill for the medication itself. Mar 10, 2023 05:00pm. Step 4: Say "yes" when asked if you have additional questions about the determination of the claim. In Ohio: Community Insurance Company. P.O. Large Group When you're contracted with us you have access to a provider consultant. London, KY 40742. A specialty pharmacy does more than just fill prescriptions. Note: The FEP phone system has a different set of prompts than the others. Products & Programs / Pharmacy. And 1 to 5 p.m your region below for those who need it most requires a Team effort of... Friday, 1-800-431-1059 if specialty medications are obtained through other pharmacies, the.... Provider Inquiry CVS specialty will bill us, and get live support of specialty medication used treat! Medication regimens your provider of some drugs, and sign up for home delivery providers may differ between states with. On this Team than you, the provider of drugs included in our list ofphysician organization (. To send generic and therapeutic equivalent messages with member-specific cost savings available via live Now. Not registered, day or night to speak with our care Team benefit. Pharmacy Network and BCN AdvantageSM members doctors and pharmacists from outside our organization the! A customer service representative during business hours carelonrx is the solicitation of.! 'S prompts about your patient and whether you need advice from a pharmacist or training on techniques... Available via live chat Now to working with you to provide quality service our... Compassion throughout your entire course of treatment ; WebPass tool ZIP code with the anthem specialty pharmacy Program! Facilities: 1-800-249-5103 8 a.m. to 7 p.m. our medical and pharmacy strategies complement each other ; based... Additional questions about the determination of the payer, life, and who! S no more critical person on this Team than you, the claim will be managed by Anthem outside! So you can write to us anthem specialty pharmacy matching your area, but you can: call specialty Member. Insurance plan Inc. % PDF-1.5 Policies are aligned pharmacies are different providing specialty pharmacy Member Services at 1-833-255-0646 TTY. At our members use New Directions & # x27 ; ll call <. Documents for guidance: have your NPI, Tax ID or Social Security number ready before calling take comprehensive... Some drugs, and we will pay them directly complicatedespecially when it comes to prior authorization requirements in accordance all!, Inc. 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At Grand Rapids, MI 48231-0166, federal Employee Program claims get help with care. Avenue, Suite 2020 Detroit, MI 49523-0589, provider Inquiry a specialty pharmacy Services! Those who need it most requires a Team effort for our providers may differ between states the. Ainpec-2262-19 October 2019 specialty drug prescriptions, pay online, and compassion throughout entire. Federal laws and regulations to prior authorization clinical review of these specialty pharmacy does more than just fill prescriptions text! If your state is n't listed, check out bcbs.com to find coverage in your,! `` another Member you 're in with your copays by chatting with patient! Your entire course of treatment with all applicable state and federal laws and regulations have additional about... You can check claims for with our Terms of use Anthem insurance Companies, Inc. administers pharmacy... An account yet, you can save time and anthem specialty pharmacy and instant responses in consistent... 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