Ready Reference Guide UPDATE 01-01-16 in Ohio Products (Contact f the address f returning checks) Local Products Blue Access Blue Preferred Blue Traditional Blue Access Options PPO f ERC Health 7/1/15 Blue Access Options PPO (Ohio Standard 3 Tier) 10/1/15 On Exchange - Individual: Pathway X Tiered PPO Netwk Eff 1/1/16 Pathway X HMO Netwk Off Exchange - Individual: Pathway Tiered PPO Netwk Eff 1/1/16 Pathway HMO Netwk Group and Individual Policies: *888-290-9160 CDHP/HDHP Plans: 1-888-224-4902 (855) 854-1438 JWR JWV (855) 854-1438 JWT YRG, YRJ, YRL YRM, YRN, YRO, YRP, YRQ, YRT, YRB, YRY VXA XDV YFS Ohio (Local) Products Ohio On Exchange Individual Products Ohio Off Exchange Individual Products Precert: 800 752-1182 Peer to Peer: 888-870-9342 Fax: 800-266-3504 UM Appeals Fax: 888-859-3046 Predetermination of Benefits: 800-752- 1182 CM: 888-662-0939 CM email: centregcmref@anthem.com Demographic, Admit and D/C Dates:.OhioAdmitting@anthem.com Clinical Infmation:.precert@anthem.com PT/OT - Orthonet eff 11/1/15: Phone: 1-844-282-6994 Fax: 1-844-216-1599 Via www.thonet-online.com Precert: 800 752-1182 Peer to Peer: 888-870-9342 Fax: 800-266-3504 UM Appeals Fax: 888-859-3046 Predetermination of Benefits: 800-752-1182 CM: 888-662-0939 CM email: centregcmref@anthem.com Demographic, Admit and D/C dates:.ohioadmitting@anthem.com Clinical Infmation:.precert@anthem.com PT/OT - Orthonet eff 11/1/15: Phone: 1-844-282-6994 Fax: 1-844-216-1599 Via www.thonet-online.com
On Exchange - Small Group: Blue Access Netwk (855) 854-1438 JWJ (Contact f the address f returning checks) Ohio On Exchange Small Group (SHOP) Products Off Exchange - Small Group: Blue Access Netwk (855) 854-1438 JWQ Ohio Off Exchange Small Group (SHOP) Products Associates (HRA/HSA) 1-800-676-2583 WLU Associates Precert: 1-877-875-1223 UM Fax: 1-888-438-7061 CM: 1-855-537-3347 Diag Imaging, Sleep Therapy, Oncology Rx: 1-866-792-1072 National (non-auto) 866-253-6066 Most have "AN" in 4th and 5th digits Eligibility, Claims Status, Links to National Precert: 866-776-4793 Peer to Peer: 800-821-1453 Fax: 800-773-7797 UM Appeals: 800-927-4065 UM Appeals Fax: 317-287-5968 CM: 800-737-1857 CM email: INDYNatlAccts- CM@wellpoint.com CM Fax: 317-287-5864 Request UM Criteria: 877-814-4803 Demographic, Admit and D/C Dates: INAdmittingNational-@anthem.com Clinical Infmation: UMNationalUnit@anthem.com
National (Auto) GM: 1-800-345-4907 Delphi: 1-800-345-4907 Fd: 1-800-367-5893 Chrysler: 1-800-848-2405 UAW: 1-866-324-9666 UGG and UFL (Medicare-MI): Facility: Eligibility and benefits 800-249-5103 Claims 800-482-0898 Professional: Eligibility and benefits 800-344-8525 Claims 800-482-3146 GM: Eligibility, Claims GHP,GIH, Status, Links to GMJ, GMH Delphi: DEH, DKP Fd: FGP, FSP Chrysler: DXP,DCH, DZW UAW: UGD,UGG, UFK,UFL, UCK,UDC (Contact f the address f returning checks) Contract issues: Blue Cross and Benefit issues: member must appeal to BCBS MI Refer to patient ID card. Preauthization: Fax 1-866-311-9603 mail to: Blue Cross of Michigan P.O. Box 2227 Detroit, MI 48231-2227 Mail code 0450 GM and Chrysler Radiology precert - AIM Specialty Health: 1-800-554-0580 Fax 1-888- 730-2831 GM GeoBlue 1-855-282-3517 QHH GeoBlue 1-800-952-3404 Provider Finder (BlueCard Netwk) Precert - route to Home Plan 800 810 BLUE 800 676 BLUE Refer to Member's ID Card BlueCard (Non-Ohio Blue Cross and Members' Plans) Infmation dependent upon availability from Blue Plan's frontend system ITS/Blue Card Dept P.O. Box 105557 Atlanta, GA 30348-5557 Call the number on the back of the member's ID card BlueCard Provider Service 866-594-0521 Federal Employee Program (FEP) 1-800 451-7602 1-800-242-9635 IVR: claim status, checks,, eligibility, benefits R Claim status (high level) Federal Employee Program (FEP) Non Clinical: P.O. Box 105557 Atlanta, GA 30348-5557 PO Box 105568 Atlanta, GA 30348 Clinical: 1351 William Howard Taft Rd. Cincinnati, OH 45206 Attn: FEP Provider Appeals,, Precert: 800-860-2156 Peer to Peer: 800-860-2156 Fax: 800-732-8318 Fax - ABD: 877-606-3807 CM: 800 711-2225 Demographic, Admit, D/C and Clinical Infmation: fepe-reviews@anthem.com Federal requests f pre-determination can not be handled through e-review please refer provider to customer service number on the back of the member s card. Medicare Supplement Products 800-345-4344 YRR Seni Services Fax: 888-859-3046 No Precert f Medicare supplement plans.
Medicare Advantage EMPLOYER GROUP eff 1/1/15 Seni Advantage HMO Medicare Preferred LPPO-Local PPO Blue Medicare Access RPPO-Regional PPO Medicare Advantage INDIVIDUAL: new plan names eff 1-1-2016 MediBlue Essential (HMO) MediBlue Plus (HMO) MediBlue Connect (HMO) (PPO) Enhanced (PPO) Ce (RPPO) (RPPO) MediBlue Dual Advantage (HMO SNP) 1-800-467-1199 YRA (HMO) 1-855-690-7796 1-855-690-7801 1-800-467-1199 1-855-690-7796 YRE (LPPO) YRS (RPPO) JRI VOC VOD JRG (Contact f the address f returning checks) Claims, Links to Claims, Links to Attn: Seni Appeals 4361 Irwin Simpson Rd. Mason OH 45040 Attn: Seni Appeals 4361 Irwin Simpson Rd. Mason OH 45040 Precertification: 1-866-797-9884 Fax - Inp notifications & all Outpatient: 1-866-959-1537 Fax- Facility Clinical: 1-877-423-9972 SNF, LTAC, Inpat Rehab: 1-800-262-2731 Fax f SNF, LTAC, Inpat Rehab: 1-877- 423-9972 Predetermination of Benefits: 1-866-797-9884 Peer to Peer: 1-866-797-9884 P2P Email: crp2p@anthem.com CM: 1-866-797-9884 opt. 4 CM email: CM-concierge@ wellpoint.com anthem.ohio.medicare@anthem.com F ALL Central Zone Medicare Advantage, regardless of CZ state Precertification: 1-866 -797-9884 Fax - Acute Inp notifications & all Outpatient: 1-866-959-1537 Fax - Facility Clinical: 1-877-423-9972 SNF, LTAC, Inpat Rehab, Inpat non-acute: 1-800-262-2731 Fax f SNF, LTAC, Inpat Rehab, Inpat nonacute: 1-877-423-9972 SNF, LTAC, Acute Rehab Initial Concurrent reviews: OHDischargeplanning@anthem.com Predetermination of Benefits: 1-866-797-9884 Peer to Peer: 1-866-797-9884 P2P Email: crp2p@anthem.com CM: 1-866-797-9884 opt. 4 CM email: CM-concierge@wellpoint.com anthem.ohio.medicare@anthem.com F ALL Central Zone Medicare Advantage, regardless of CZ state Orthonet Phone: PT,OT 1-844-340-6418 Spine & Back PM, Spinal Surgery 1-844-788-4805 Orthonet Fax: PT,OT 1-844-340-6419 Spine & Back PM, Spinal Surgery 1-844-788-4806 Orthonet Cardiology eff 4/1/15: Phone 1-844-278-5477 Fax: 1-844-876-4924
ebusiness Help Desk: 1-866-755-2680 Call to reset My f Provider passwd f assistance with technical difficulties Other Infmation Dental: 1-866-947-9398 Behavial Health Precert: 1-866-582-2293 CAQH: 1-888-599-1771 Orthonet Focused Claim Review Radiology, Cardiology, Sleep, Radiation Therapy, Cancer Care Quality Program (f those products that apply) Phone 888-730-2817; Hours 8:30 7:00 ET See Precertification page in provider section of www.anthem.com AIM Precertification via: www.availity.com Website: www.aimspecialtyhealth.com: Clinical guidelines here Optinet Surveys/Site Assessments Help Desk: 1-800-252-2021 optinetsuppt@aimspecialtyhealth.com My Provider Ptal **Commercial and Medicare Advantage Phone: 1-888-230-1346 Fax: 1-866-951-2711 Provider Solutions Nthern Ohio: 216-573-4440 Central Ohio: 614-438-3400 Southern Ohio: 513-770-7607 Availity www.availity.com Phone: 1-800-282-4548 AIM can enter cases retro 2 business days only. Eff August 22, 2015 - these can be done online. After that timeframe, use the post service review/reconsideration process.* UM Services *Medicare Advantage: No retros allowed. Effective in 2015, failure to obtain a pri authization will result in an administrative denial and members cannot be balance billed. Reminder: AIM Specialty Health does not precert Radiation Therapy and Specialty Pharmacy f Medicare Advantage members. Specialty Pharmacy Precertification - Does not include Specialty RX under Pharmacy Benefit *Change site administrat by emailing central.eprovider.rep@anthem.com Eligibility and Benefits, Claims,, Precertification. Fee Schedules, On-line Remittance, Reimbursement policies, MA Provider Self Service: via link out to Provider Ptal AIM Specialty Health Precertification Retrospective Precertification National: check members ID card Commercial: Aimspecialtyhealth.com via Availity Clinical Data Submission Tools available on www.anthem.com under the Ohio Provider Page specialtymeds@anthem.com Fax 866-993-5966 Medicare Advantage: Phone 866-797-9884 option 5, Fax 866-959-1537 with General Precert Fm (anthem.com Precertification page) Medicare Advantage Email: maspecialtypharm@anthem.com FEP: submit ABD (with clinical) to fax 877-606-3807 Request f Claim Review, Adjustment Submitting Recds PO Box 105557 Atlanta, GA 30348-5557 Fax: 1-800-376-0247 Include completed Provider Adjustment Request Fm, a letter with all pertinent claim and patient details. **If you receive a recd request letter, follow the instructions on the letter f returning them. Refunding Checks If you are returning a check issued by, please mail to: Finance Dept. 1351 William Howard Taft Mail-Point: CW1-262 Cincinnati, Ohio 45206 EDI Solutions Help Desk: 800 470 9630 Email: e-solutions.suppt@anthem.com Electronic Data Interchange Infmation Available Online: http://www.anthem.com/edi/ (Select OH & click enter) EDI Pay IDs: Professional - 00834; Facility - 00332 is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Association. ANTHEM is a registered trademark of Insurance Companies, Inc. The Blue Cross and names and symbols are registered marks of the Blue Cross and Association.