This provider manual, as part of your provider agreement an. Anthem blue cross and blue shield is the trade name of community insurance company. Nov 20, 2020 hoosier healthwise and health indiana plan. Healthy indiana plan basic medicaid approved preferred drug list.
This new process will allow for a retroactive pa for services after the individual has been determined fully eligible for benefits. Family and social services administration office of. Providers who are contracted with anthem blue cross and blue shield to serve hoosier healthwise, healthy indiana plan and hoosier care connect through an accountable care organization aco, participating medical group pmg or independent physician association ipa are. In each class, drugs are listed alphabetically by either brand name or generic name. Download and log in to our new sydney mobile app thats your special health ally for personalized wellness activities, 247 digital assistance and more. Medicare, medicaid and other commercial insurers see. A care management program for people who need help using their health care benefits. For indiana dentists indiana state dental plans dentaquest. In such cases, anthem will make every effort to provide updated. Healthy indiana plan hip anthem bluecross blueshield. Box 29044 hot springs, ar 71903 ffs pharmacy claim. Tty 711 get the mobile app lets make healthy happen.
Login anthem bluecross blueshield indiana medicaid. Call our member helpline at 1800553 2019 for assistance or. Hip is a health plan for uninsured adults ages 1964. In colorado rocky mountain hospital and medical service, inc. Indiana provider manual july 2019 anthem blue cross blue. Opr provider verification ihcp providers should verify enrollment of the ordering, prescribing, or referring opr provider before services or supplies are rendered. Approval date 1220 2019 department approvalsignature. It isnt part of the healthy indiana plan member handbook. Indiana state dental plans medicare, medicaid, chip dental.
This provider manual, as part of your provider agreement and related. This manual will be used as a reference handbook for the family and social services administration fssa office of medicaid policy and planning ompp and. August 2019 anthem provider news indiana download as pdf. Indiana health coverage programs prior authorization. Impacted provider types pts are 19 nursing facility and 65 hospice, long term care. Hoosier healthwise is a health plan for children, pregnant women and low income families.
Please call your provider relation representative or the provider help line applicable to the members health plan. August 2019 anthem provider news indiana page 4 of 28 new location for provider manuals on anthem. Dec 22, 2020 provided through the managed care delivery system including healthy indiana plan hip, hoosier care connect, or hoosier healthwise services providers must contact the members managed care entity mce or refer to the mce provider manual. Oct 22, 2020 when a claim is cost avoided, the provider must bill the appropriate third party. By carol hoppe, cpc, ccsp, cpci medlucid solutions note. Anthem provides health care professionals with supporting resources to help your relationship with us run as smoothly as possible. October 2019 anthem provider news indiana page 2 of 40 m edicaid. Anthem hoosier healthwise, and hoosier care connect anthem blue cross and blue shield version 2.
Provider resources for indiana community plan products including prior authorization information, provider manuals, forms, recent news and more. The enrollment effective start date is the date the provider enrollment unit receives the completed. Providers who are contracted with anthem blue cross and blue shield to serve hoosier healthwise, healthy indiana plan and hoosier care. The state of indiana coordinates with indiana s prosecuting attorneys, law enforcement, and the family and social services administration to ensure the safety of adults in need. Anthem blue cross and blue shield is the trade name of. The updated rates are effective on claims with dates of service on or after january 1, 2021. Jul 01, 2019 update to provider um reimbursement penalties and corresponding update to provider manual.
This manual will be used as a reference handbook for the family and social services administration fssa office of medicaid policy and planning ompp and other state contractors and partners. Anthem blue cross anthem is committed to supporting you in providing quality care and services to the members in our network. The provider manual is designed for network physicians. Update to provider um reimbursement penalties and corresponding update to provider manual. Here you will find the anthem provider manuals, guidelines for clinical utilization management um, medical policies and coding spotlights for common conditions. Home anthem blue cross and blue shield healthcare solutions. Anthem blue cross and blue shield is one of the trusted providers for the. We have consolidated our resources for dental providers to make it easier to find the tools and information you need. Righ this manual is designed to assist you with education about bluecard and interplan business. Medicare part c is also called medicare advantage ma. Cdc 2019 novel coronavirus real time rtpcr diagnostic test. Effective april 1, 2019, a new prior authorization pa process will be in place for indiana health coverage programs ihcp providers that assist individuals with a healthy indiana plan hip fast track prepayment. Identify medicaid recipients who need to have their medicaid recertification completed and approved by the state agency in order to remain eligible to receive medicaid benefits. Anthem provider files must match indianas provider informatio.
Caresource values our relationships with our providers, and we are actively working to make it easier for you to deliver quality care to our members. Dec 1, 2020 2minute videos to engage patients about preventive care. Anthem updates crna payment policy for indiana medicaid plans. If you are eligible for medicaid, choose anthem to manage your insurance. The indiana health coverage programs ihcp medical policy manual contains information about indiana medicaid policies. Tenncare medicaid covers all medicaid mandatory eligibility groups as well as. Visit to register for our web portal and find policies, forms, and the latest newsletter. Family and social services administration office of medicaid. Aug 1, 2019 administrative anthem blue cross and blue shield anthem has launched a new page on anthem. Download provider manuals for professionals, facilities, and others for more on our.
Independent licensee of the blue cross and blue shield association. Medical policies and clinical utilization management. The information provided here is the most currently available as of march 20. Anthem blue cross and blue shield indiana medicaid provider manual for hoosier healthwise, healthy indiana plan and hoosier care connect. Medicaid state contracts, regulatory guidance and cms requirements supersede interqual. Quality improvement program california provider anthem. Anthem provider files must match indianas provider information. Anthem products contact phone numbers provider services health information provider directories network eupdates. Medicaid members can access information with our medicaid app. Mhs provider manual pdf, updated november 30, 2020 indiana medicaid provider manual pdf mhs provider quick reference guide pdf, updated november 30, 2020 mhs dental provider manual pdf. Unitedhealthcare community plan of indiana homepage.
Indiana medicaid provider manual pdf mhs provider quick reference guide pdf, updated november 30, 2020. Providers must be fully aware of and comply with the procedures outlined in this document to prevent claims from being erroneously cost avoided. Mce contact information is included in the ihcp quick reference guide. Anthem updates crna payment policy for indiana medicaid. Clinical criteria for utilization management decisions. Indiana state dental plans medicare, medicaid, chip.
In indiana, anthem medicare advantage plans include all the benefits of original medicare, parts a and b, plus medicare part d prescription drug coverage included with most plans and extra benefits for medicareeligibles like dental and vision that medicare doesnt cover. Oct 20, 2020 hoosier healthwise and health indiana plan. Indiana health coverage programs prior authorization request form. When a claim is cost avoided, the provider must bill the appropriate third party. Caresource has provided medicaid and other managed health care services since 1989. This provider manual w ill present a general overview of information. Anthem blue cross and blue shield indiana medicaid provider. We are pleased to notify you that the updated 2019 manual is now available online and you can view it here. Oct 01, 2019 hoosier healthwise and health indiana plan. Ainpec223419 june 2019 clinical utilization management guidelines the new clinical utilization management. Amerigroup community care is a wholly owned subsidiary of anthem, inc. The following documents comprise the michigan medicaid provider manual and address all health insurance.
Indiana health coverage programs prior authorization request form feeforservice gainwell technologies p. Effective healthy indiana plan hoosier care connect, anthem anthem. Managed health services mhs managed health services mhs is a managed care entity mce that has contracted with the state of indiana to serve medicaid recipients enrolled in. Policy applies to health plans operating in the following states. Clinical criteria for utilization management decisions core. Hoosier healthwise is a health plan for children, pregnant women and lowincome families. May 15, 2019 notification regarding anthem fee schedule changes. Ihcp quick reference guide contact information indiana. Find a doctor anthem bluecross blueshield indiana medicaid. Anthem does not advise providers what codes to bill with, therefore, you. The provider search tool enables you to locate providers enrolled with the ihcp to provide services to medicaid members. Hoosier care connect hcc anthem bluecross blueshield. Covered services rendered to the hip members will be reimbursed at % of the current hoosier healthwise fee schedule, while hoosier care connect and hoosier healthwise members will be reimbursed at 100% of the current hoosier healthwise fee schedule. Anthem blue cross and blue shield is the trade name of anthem insurance companies.
The state of indiana selected anthem blue cross and blue shield anthem, caresource. Mar 20, 2020 indiana medicaid updates its telehealth guidance. Or, call the member services number on the back of your member id card. Kentucky, beginning august 1, and new york, virginia, and wisconsin, beginning september 1. Notification regarding anthem fee schedule changes may 1, 2019. Sep 24, 2020 provider manual for hoosier healthwise and hip. In missouri excluding 30 counties in the kansas city area.
Anthem blue cross and blue shield is the trade name of anthem insurance companies, inc. Healthy indiana plan hip 877 438 4479 hoosier care connect 866 963 7383 hoosier healthwise anthem provider services anthem. Find out how to apply for medicaid in your state at the official site. The anthem bluecard program provider manual january 2019 kentucky, inc. The same policy also will apply to anthem s medicaid plans in four states. Download provider manuals for professionals, facilities, and others for more on our programs and policies. Anthem blue cross and blue shield in indiana anthem is committed to providing providers and facilities with an accurate and up to date manual. The medical policy manual has been developed to ensure the success of the indiana health coverage programs ihcp. Emergency department professional claims with the highest potential for upcoding will be selected, the payer said. Call our member helpline at 18005532019 for assista. If that resource denies payment or pays less than the ihcp would have paid, the provider can rebill the claim to the ihcp.
To receive reimbursement for services covered under the ihcp, including medicaid services, a provider must be eligible and actively enrolled in the ihcp. Multiple services are available through aps which is dependent upon the levelofneed of the individual. The rates were updated in the medicaid management information system mmis on january 19, 2021. Indiana health coverage programs provider reference module. Caresource provider manual dear caresource provider, thank you for your participation.
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