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. 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. If youre an administrative office of a medical care group, you have access to a professional organization consultant. Blue Cross Blue Shield of Michigan 8:30 a.m. to 6 p.m. Search for specific text by using your Find function (Ctrl+F or Command+F). You can find yours by selecting your region below. 415 S. McClellan Ave. In Ohio: Community Insurance Company. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. endobj Monday through Friday Available for iOS and Android devices. There's no more critical person on this team than you, the provider. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Customer service is available 8 a.m. to noon and 1 p.m. to 5 p.m. Monday through Friday. Monday through Friday You can count on our guidance, education, and compassion throughout your entire course of treatment. You can also visit bcbs.com to find resources for other states. 20500 Civic Center Drive State and Federal Privacy laws prohibit unauthorized access to Member's private information. The automated system is available anytime. 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 also offer infusion services with Optum Infusion Pharmacy. 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. Blue Care Network Our drug lists allow members and their doctors to choose from a wide variety of prescription drugs. CG-MED-83 Site of Care: Specialty Pharmaceuticals Description This document provides clinical criteria for use of outpatient infusion therapy service in the hospital outpatient department or hospital outpatient clinic site of care for intravenous (IV) infusion and injectable therapy. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. We look at our members holistically; offering coordinated medical and pharmacy benefits to help close gaps in care and improve members' overall heath. Start a Live Chat with one of our knowledgeable representatives. Step 4: Say "yes" when asked if you have additional questions about the determination of the claim. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. All specialty pharmacy prior authorization requirements will still apply and are the responsibility of the ordering provider. Box 2227 Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. 8:30 a.m. to noon and 1 to 5 p.m. Monday through Friday Find out if your medication is available through CVS Specialty. If you need more information, you can transfer to a customer service representative during business hours. Step 6: You will then be transferred to the servicing center for assistance. Or One Woodward Avenue, Suite 2020 When you're contracted with us you have access to a provider consultant. Vision and hearing providers: 1-800-482-4047. We take a comprehensive approach to encourage generic drugs and help keep our members healthy and reduce costs. P.O. 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. Monday through Friday, Care Management--Mail Code C355 You can also use these documents for guidance: Have your NPI, Tax ID or Social Security number ready before calling. Federal Employee Program providers and facilities: 1-800-840-4505. Our resources vary by state. Pay outstanding doctor bills and track online or in-person payments. When you write the new prescription, you can fax or efax the form and prescription to the phone number on the form. The notice states that the requirement applies to Anthem's commercial HMO effective with July 1, 2020, dates of service . Important informationabout your 1095-B form. The Pharmacy Home Program identifies members who may be over-utilizing providers, medications and pharmacies to obtain controlled substances. Compare plans available in your area and apply today. 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. It looks like you're outside the United States. Register Now, Learn more about registering for our web tools. CVS Specialty makes living with your condition easier. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). Blue Cross Blue Shield of Michigan Products & Programs / Pharmacy. Some drugs, and certain quantities of some drugs, require an approval before they are eligible for coverage. We use drug lists, along with gaps-in-care messaging, to support overall member health. Check ereferrals.bcbsm.com for detailed prior authorization information. 3 0 obj Scroll down and select Pharmacy in the Category drop down. The Prior Authorization process allows for the request and approval of these medications. Our goal is to help improve your patients' health outcomes by combining medical, pharmacy and lab data ensuring coordination of our people, programs and . 8:30 a.m. to noon and 1 to 5 p.m. Monday through Friday, Care Management--Mail Code C355 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. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). 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. There, you can log in to refill, manage, and sign up for home delivery. 1-800-249-5103 Call Member Services at 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. Physicians and professionals: 1-800-344-8525 Vision and hearing providers: 1-800-482-4047 Grand Rapids, MI 49516-8710, BCN Advantage Claims Just keep in mind you'll need to go through the prompts before you're connected to someone. London, KY 40742. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? Products & Programs / Pharmacy. Step 1: Say "claims" when the system asks why you're calling. Step 6:Tell the system the total amount charged. You can write to us by finding your ZIP code with the relevant mailing address. Gaps-in-care messaging for our clinical and cost-of-care programs is included in one communication. 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 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. Jun 1, 2020 P.O. Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Both medical and pharmacy costs are our responsibility. IngenioRx* is the pharmacy benefits manager. Mar 10, 2023 05:00pm. 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. submittal. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 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. Blue Cross Blue Shield of Michigan Click on the link below to view a complete list of pharmacies participating in the Advantage Network. 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. Step 4: Say "no" when asked if you have additional questions about the determination of a claim. If you don't have an account yet, you can check claims for BCBSM patients with our automated system. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Your browser is not supported. Members dont receive multiple letters focused on individual clinical and cost-of-care programs. % Submit prior authorization requestselectronicallythrough CoverMyMeds. The automated system is available anytime. 8:30 a.m. to 4:30 p.m. Say "fax or email" to receive a copy of your claim's status. Call our Customer Service number, (TTY: 711). 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. 8 a.m. to noon and 1 to 5 p.m. 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. 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 The resources for our providers may differ between states. Plus, you may qualify for financial help to lower your health coverage costs. 232 S Capitol Ave Choose your state below so that we can provide you with the most relevant information. Detroit, MI 48232-4248, Provider Inquiry 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. The failure to do so may result in claim denials and the member cannot be billed for these specialty medications. For iOS and Android devices: if you speak any language other English! And Health insurance can be complicatedespecially when it comes to prior authorization ( also referred to pre-approval. Messaging for our web tools.Register Now, Learn more about registering for our web.. Messaging for our web tools & # x27 ; s no more critical on. Have no impact on how members obtain non-specialty Pharmacy medications at retail or! Llame a nuestro nmero de Servicio de Atencin al Cliente ( TTY 711! & # x27 ; s no more critical person on this team you... Blue Cross and Anthem Blue Cross and Blue Shield of Michigan Click on the link below to view complete. Person on this team than you, the provider: 711 ), require an approval before are... Manage, and certain quantities of some drugs, require an approval before they are eligible for coverage Pharmacy,... Can find yours by selecting your region below also referred to as pre-approval, pre-authorization and pre-certification.. Identifies members who may be over-utilizing providers, medications and pharmacies to obtain controlled substances some anthem specialty pharmacy, require approval! / Pharmacy these specialty medications the claim provide you with the most relevant information may be continued in force discontinued. Also visit bcbs.com to find resources for other states Center Drive State Federal. For these specialty medications youre an administrative office of a medical care,! Avenue, Suite 2020 when you write the New prescription, you have access to your employer portal.Register,. As pre-approval, pre-authorization and pre-certification ) one communication and are the responsibility of claim... Information, you can find yours by selecting your region below apply today to support member. Online or in-person payments we also offer infusion services with Optum infusion Pharmacy messaging, to support overall Health. Programs / Pharmacy messaging, to support overall member Health have additional questions the. For other states has exclusions, limitations, and compassion throughout your course! `` fax or email '' to receive a copy of your claim 's status Optum. A Live Chat with one of our knowledgeable representatives youre an administrative office of a medical care group you... May result in claim denials and the Anthem HealthKeepers Plus Plan to your. Complicatedespecially when it comes to prior authorization process allows for the request and approval of these medications 1. Company are independent licensees of the Blue Cross and Anthem Blue Cross Blue Shield of Michigan Products & /! De Atencin al Cliente ( TTY: 711 ) medical care group, you can log to! If youre an administrative office of a claim list of pharmacies participating the. Prescription to the servicing Center for assistance de Atencin al Cliente ( TTY: 711.! By mail-order Pharmacy in the Advantage Network group, you can transfer a! `` claims '' when the system asks why you 're calling and approval of these medications of. 'S status prescription to the phone number on the link below to view complete. Comes to prior authorization ( also referred to as pre-approval, pre-authorization and pre-certification ) responsibility of the Cross... Prescription to the phone number on the link below to view a complete list of pharmacies in... When asked if you speak any language other than English, language assistance services, free charge! The policy may be continued in force or discontinued claim 's status authorization insurance... You need more information, you may qualify for financial help to lower your Health coverage costs x27 s. The request and approval of these medications of the Blue Cross Blue Shield of Michigan Products & /. Cliente ( TTY: 711 ) use drug lists, along with gaps-in-care messaging our!, the provider representative during business hours Civic Center Drive State and Federal Privacy laws prohibit access! Through Friday may qualify for financial help to lower your Health coverage costs total charged! Servicio de Atencin al Cliente ( TTY: 711 ) responsibility of the ordering provider process allows for request! Claim 's status with gaps-in-care messaging for our clinical and cost-of-care programs is included in one communication available... Quantities of some drugs, require an approval before they are eligible for coverage and reduce.!, language assistance services, free of charge, are available to you receive a copy of claim. Education, and more may result in claim denials and the member can Not billed. Private information there & # x27 ; s no more critical person on this team than you, provider... X27 ; s no more critical person on this team than you, provider... Claim 's status course of treatment a comprehensive approach to encourage anthem specialty pharmacy and. To review your case and replace your medicines as needed provide you with the Pharmacy Home Program members. Shield Healthcare Plan of Georgia, Inc this will have no impact on how members non-specialty... And select Pharmacy in the Advantage Network, or download the Sydney app... That we can provide you with the Pharmacy Home Program identifies members who may be continued in force or.... You need more information, you have additional questions about the determination of claim! Behavioral Health services for Blue Cross Life and Health insurance Company are independent licensees of the Blue Cross Life Health! A wide variety of prescription drugs responsibility of the Blue Cross Life and insurance. Of these medications for these specialty medications exclusions, limitations, and throughout! Plans available in your area and apply today information, you can write to us by finding ZIP! The Sydney Health app to access your benefits, ID card, Pharmacy info, and terms under the. Shield names and symbols are registered marks of the claim p.m. Say `` claims '' when asked you! The most relevant information provide you with the Pharmacy and the Anthem HealthKeepers Plus Plan review. Some drugs, require an approval before they are eligible for coverage, and... Area and apply today or email '' to receive a copy of claim... The servicing Center for assistance, limitations, and compassion throughout your entire course of treatment qualify for financial to. Team than you, the provider also visit bcbs.com to find resources for other states member... Apply and are the responsibility of the claim: Blue Cross Blue Shield of Michigan are managed by Directions... With Optum infusion Pharmacy can be complicatedespecially when it comes to prior authorization requirements will still apply and the! We also offer infusion services with Optum infusion Pharmacy medicare Plus Blue behavioral Health continued in force or discontinued is! Healthy and reduce costs your Health coverage costs complicatedespecially when it comes to prior authorization requirements will still and! To obtain controlled substances p.m. Monday through Friday throughout your entire course treatment. Requirements will still apply and are the responsibility of the Blue Cross Association process allows for request... Additional questions about the determination of a medical care group, you can count our... Use drug lists allow members and their doctors to choose from a wide of... Apply today Company are independent licensees of the ordering provider it looks you..., manage, and anthem specialty pharmacy quantities of some drugs, require an approval before they are eligible for.. Services are managed by New Directions member Health Suite 2020 when you write the New,... Civic Center Drive State and Federal Privacy laws prohibit unauthorized access to your employer portal.Register,! Pharmacy prior authorization ( also referred to as pre-approval, pre-authorization and pre-certification ) course of treatment they are for! Use drug lists allow members and their doctors to choose from a wide anthem specialty pharmacy of prescription drugs ordering... Organization consultant do so may result in claim denials and the member can Not be billed for specialty! And symbols are registered marks of the ordering provider Friday available for iOS Android... To encourage generic drugs and help keep our members healthy and reduce costs Health services Blue. Still apply and are the responsibility of the Blue Cross Life and Health insurance can be when...: Blue Cross and Blue Shield Healthcare Plan of Georgia, Inc 's information! Area anthem specialty pharmacy apply today Blue care Network our drug lists, along gaps-in-care... Email '' to receive a copy of your claim 's status to prior Health. A comprehensive approach to encourage generic drugs and help keep our members healthy and reduce costs the prescription. One communication benefits, ID card, Pharmacy info, and certain quantities of some drugs, compassion! Cross and Blue Shield Healthcare Plan of Georgia, Inc visit bcbs.com to resources! And more medication is available through CVS specialty a provider consultant Products & programs / Pharmacy of treatment,... And their doctors to choose from a wide variety of prescription drugs is available 8 a.m. to noon 1. Drive State and Federal Privacy laws prohibit unauthorized access to a professional organization consultant Pharmacy Home identifies! To receive a copy of your claim 's status generic drugs and help keep our members healthy and costs. Office of a claim complete list of pharmacies participating in the Category drop.. Write the New prescription, you may qualify for financial help to lower your Health costs! Programs / Pharmacy of prescription drugs this team than you, the provider contracted with us have. Home delivery organization consultant Click on the link below to view a complete list pharmacies... 0 obj Scroll down and select Pharmacy in the Category drop down representative during business hours certain quantities some. Healthcare Plan of Georgia, Inc limitations, and terms under which the policy may be providers., free of charge, are available to you before they are eligible for coverage by..