Both medical and pharmacy costs are our responsibility. Medicaid renewals are starting. 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. 8 a.m. to 5 p.m. 1-888-803-4960 CVS Specialty will bill us, and we will pay them directly. These pharmacies serve members with complex or chronic conditions. You get your health insurance plan from an employer or if you have certain grandfathered plans. P.O. Please update your browser if the service fails to run our website. 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. 1-877-258-0167 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. 1-800-482-4047 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). Your browser is not supported. Lansing, MI 48933. Detroit, MI 48231-0166, Federal Employee Program claims What you need to know about the coronavirus, COVID-19. Cost-of-care and clinical programs focus on total costs, and we encourage medications that help to reduce those total costs. Call Specialty Pharmacy Member Services at 1-833-255-0646 (TTY 711) anytime, day or night to speak with our Care Team. Step 7: Listen to your claim's status, which includes the following information: Say "same member" to inquire on another member. Detroit, MI 48321-2227, Blue Cross Blue Shield of Michigan In Connecticut: Anthem Health Plans, Inc. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. 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. submittal. Monday through Friday Your dashboard may experience future loading problems if not resolved. 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. 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. 711. We engage members and you, their doctors. As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns. 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. Say "claims" when the system asks why you're calling. We also offer infusion services with Optum Infusion Pharmacy. Use e-referral for authorizations for Blue Care Network and BCN AdvantageSM members. Log in at availity.com. We send members personalized messages about medications that may reduce their costs and include specific cost savings. There is no cost for this service. 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. Monday through Friday. Step 1: Say "claims" when the system asks why you're calling. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Explore our comprehensive guides and video resources for more information regarding your condition. Creating an account is free, easy and helps patients get their medications sooner. Your online account is a powerful tool for managing every aspect of your health insurance plan. Get help with your copays by chatting with a patient care coordinator today. Federal Employee Program providers and facilities: 1-800-840-4505. Lets make healthy happen. Not sure which region you're in? If specialty medications are obtained through other pharmacies, the claim will be denied. 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. We look forward to working with you to provide quality service for our members. We take a comprehensive approach to encourage generic drugs and help keep our members healthy and reduce costs. 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. To report fraud, waste or abuse, call our hotline: 1-800-437-3803 New member? Southfield, MI 48075. A specialty pharmacy does more than just fill prescriptions. This will have no impact on how members obtain non-specialty pharmacy medications at retail pharmacies or by mail-order. 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. We use Availity Essentials as our provider portal. View our map (PDF). Pharmacy Information for Providers. Say "date of service" to learn about a different claim. Hospitals or facilities: 1-800-249-5103 You can count on our guidance, education, and compassion throughout your entire course of treatment. 1-800-822-2761 8 a.m. to noon and 1 to 5 p.m. The Pharmacy Home Program identifies members who may be over-utilizing providers, medications and pharmacies to obtain controlled substances. We currently don't offer resources in your area, but you can select an option below to see information for that state. Box 312599 R-300913DescriptionThe Specialty Operations Pharmacy Technician 2 supports Pharmacists in SpecialtySee this and similar jobs on LinkedIn. 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. Step 4: Say "no" when asked if you have additional questions about the determination of a claim. P.O. Our resources vary by 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. We offer flexible group insurance plans for any size business. Physicians and professionals: 1-800-344-8525 We offer low-cost coverage for children, adults, and families who qualify for state-sponsored programs. 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. All you need to know about the COVID-19 vaccines and boosters.Get the details. Compare plans available in your area and apply today. Our clinical management program provides personalized care and ongoing support through 1-on-1 phone calls and follow-up consultations.Learn more. Box 33248 The automated system is available anytime. Step 5: Tell the system the date of service provided. Step 2: Answer the prompts about your patient and whether you provided care in Michigan. You can also visit bcbs.com to find resources for other states. CVS Health ( NYSE: CVS ) is a coast-to-coast healthcare conglomerate comprised of retail / mail order. Jan 1, 2021 Medication is often one of them. CVS Specialty dedicated Anthem Provider Services: Anthem Blue Cross is the trade name of Blue Cross of California. Everything we do centers ongetting you the prescriptionyou need, when you need it,your way. Attention: Claim Processing Please refer to the preferred drug list (PDL) when prescribing for these members. Say "representative" to reach someone who can help. Specialty pharmacies have highly trained pharmacists and nurses to provide personal care and guidance to help you manage your condition. Providers should continue to submit for administration of the medication, but not bill for the medication itself. Box 68710 Monday through Friday Say "another member" to inquire on another member. 4 0 obj When you email us, we'll call . Get the mobile app Automated information is available anytime. ??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. If you're interested in joining the Physician Group Incentive Program, also known as PGIP, or want more information, emailvaluepartnerships@bcbsm.com. Detroit, MI 48231-2599, Blue Cross Complete claims We are leading the health care industry in the way we choose covered drugs, analyzing the strongest clinical drug studies and member data to see how drugs are really working for patients. Anthem ( NYSE: ANTM ) is one of the largest managed care organizations in the United States. As one of the nation's leading health plans, Anthem serves millions of members in state-sponsored programs across the nation. 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 were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. It looks like you're in . New member? Step 2:Answer the system's prompts about your patient and whether you provided care in Michigan. Get access to your employer portal.Register Now, Learn more about registering for our web tools.Register Now, Not registered? 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. Specialty medications are used to treat these conditions and often require special storage or extra support. The notice states that the requirement applies to Anthem's commercial HMO effective with July 1, 2020, dates of service . endobj P.O. 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. 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. If you don't have an account yet, you can check claims for with our automated system. We provide health insurance in Michigan. <> Find answers to all your questions with an Anthem representative in real time. Vision and hearing providers: 1-800-482-4047 Understand your care options ahead of time so you can save time and money. 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. State and Federal Privacy laws prohibit unauthorized access to Member's private information. Note: The FEP phone system has a different set of prompts than the others. This allows us to send generic and therapeutic equivalent messages with member-specific cost savings. 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. You can write to us by finding your ZIP code with the relevant mailing address. 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 The Blue Cross name and symbol are registered marks of the Blue Cross Association. Detroit, MI 48232-4248, Provider Inquiry Virginia Anthem HealthKeepers Plus plan offered by HealthKeepers, Inc. Wisconsin Anthem Blue Cross and Blue Shield. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Monday through Friday Southfield, MI 48075, 1-877-293-2788 As a clinician, you play a powerful role in ensuring your patients are adherent to their medication regimens. We encourage medications that improve patient health. Blue Care Network Gaps-in-care messaging for our clinical and cost-of-care programs is included in one communication. Weve got the latest advice, tips, and news to help you get the mostout of your benefits, find the best healthcare, and stay healthy. You can write to us by finding your area code with the relevant mailing address. These pharmacies serve members with complex or chronic conditions. We currently don't offer resources in your area, but you can select an option below to see information for that state. A specialty pharmacy does more than just fill prescriptions. Taking time for routine mammograms is an important part of staying healthy. You can also visit. CarelonRx is the pharmacy benefits manager (PBM) for Anthem HealthKeepers Plus members in Virginia. 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. You can write to us by matching your area code with the relevant mailing address. Drugs used for the treatment of Oncology will still require pre-service clinical review by AIM. If you need more information, you can transfer to a customer service representative during business hours. Indiana Anthem Blue Cross and Blue Shield, Kentucky Anthem Blue Cross and Blue Shield Medicaid, Nevada Anthem Blue Cross and Blue Shield Healthcare Solutions. Monday through Friday Understand your care options ahead of time so you can save time and money. Blue Cross Blue Shield of Michigan. It can also send you a copy of your claim's status. One Woodward Avenue, Suite 2020 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. 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. You can also talk to your provider consultant. This applies to all Anthem Indiana commercial members. Marquette, MI 49855, Employee Inquiry Providing care for those who need it most requires a team effort. 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 Review medical and pharmacy benefits for up to three years. 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. 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. Providers who are Designated SRx Network providers can continue to acquire and administer the specialty pharmacy medications covered under the members medical benefit 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. The automated system is available anytime. London, KY 40742. 20500 Civic Center Drive Step 2: Answer the system's prompts about your patient and whether you provided care in Michigan. The Rx Choice Tiered Network may not be available in all states. There, you can log in to refill, manage, and sign up for home delivery. View listings below of the retail pharmacies that participate in our pharmacy networks. 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. Price a medication, find a pharmacy,order auto refills, and more. Not registered? 1-855-504-2583 Motivating your patients to adhere to their medication can contribute to improved outcomes and increased STARS performance. 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. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Preferred Drug List and Formulary Search 232 S Capitol Ave Anthem Blue Cross and Blue Shield BadgerCare Plus and Medicaid SSI Programs Specialty pharmacy site of care Page 2 of 2 . 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. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. The automated system is available anytime. If youre a professional provider office, you have access to a provider consultant. You can order by phone whether or not you're already a member. Pharmacy Information and Tools. Our automated interactive voice response system provides claims, benefit and cost-share information. We accept all major insurance plans, including Medicare Part B, Part D, Medicaid, Commercial Insurance, and manufacturer-supported patient assistance programs. Not connected with or endorsed by the U.S. Government or the federal Medicare program. endobj 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. These pharmacies serve members with complex or chronic conditions. The list of specialty pharmacy medications subject to the above will be posted on anthem.com for reference and is subject to change. 8:30 a.m. to noon and 1 to 5 p.m. When you're contracted with us you have access to a provider consultant. We use drug lists, along with gaps-in-care messaging, to support overall member health. Get access to your online account.Register Now, Not registered? 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. A specialty pharmacy does more than just fill prescriptions. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). If you're not a Blue Vision provider, send claims to: VSP Specialty pharmacies are different. We look at claims data to find opportunities for our members to save money by switching them to lower-cost, therapeutically equivalent drugs. Click on the link below to view a complete list of pharmacies participating in the Advantage Network. Make your mental health a priority. You can find yours by selecting your region: Not sure which region you're in? Medicare Complaints, Grievances & Appeals. Search for brand and generic medications by condition, or download the CVS Specialty drug list as a PDF (PDF). 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. Step 4: Say "yes" when asked if you have additional questions about the determination of the claim. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Providers may continue to submit a claim for administration of the specialty pharmacy medications, which will be reimbursed at the current contracted rates. 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. Plus, you may qualify for financial help to lower your health coverage costs. Click on the link below to view a complete list of pharmacies participating in the Performance Network. Independent licensees of the Blue Cross and Blue Shield Association. Ascension reports 2.9% operating margin in H1 2023, says improvement plan is beginning to make headway. 8 a.m. to 4 p.m. Find out if your medication is available through CVS Specialty. They will work with the pharmacy and the Anthem HealthKeepers Plus plan to review your case and replace your medicines as needed. Register Now, Not registered? 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). The automated system is available anytime. Posted 10:46:35 PM. In Indiana: Anthem Insurance Companies, Inc. 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. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Members have one vendor, one contact, and one ID card. If you misplace your medicine or it is stolen, contact your provider. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Available for iOS and Android devices. 1-800-378-0323 Specialty pharmacy Call 1-833-262-1726 Fax 1-833-263-2871 For more information, visit our Manage your prescriptions page. Detroit, MI 48226. 8:30 a.m. to noon and 1 to 5 p.m. For costs and complete details of the coverage, please contact your agent or the health plan. 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., 2022. Choose your location to get started. Monday through Friday, Care Management--Mail Code C355 We also offer infusion services with Optum Infusion Pharmacy. Facility and Special Programs 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. Physicians and professionals: 1-800-344-8525 Don't have a secured provider portal account yet? 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. Portal account yet members personalized messages about medications that help to lower your health coverage.... Healthy and reduce costs to support overall member health Pharmacists and nurses provide! And guidance to help you manage your condition Servicio de atencin al Cliente ( 711! Home delivery, Inc. administers its pharmacy benefit and establishes prior authorization requirements in accordance with all state. 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