anthem specialty pharmacy

Monday through Friday. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. These pharmacies serve members with complex or chronic conditions. 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. Members taking specialty drugs may need to get their prescription filled at an in-network specialty pharmacy in order for their drug to be covered under their pharmacy or medical benefit. These medications are delivered to your home or shipped to a local CVS pharmacy for pickup. 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. 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. You can write to us by finding your area code with the relevant mailing address. Use our app, Sydney Health, to start a Live Chat. The resources for our providers may differ between states. Your dashboard may experience future loading problems if not resolved. <>>> 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. You get your health insurance plan from an employer or if you have certain grandfathered plans. Detroit, MI 48232-4248, Provider Inquiry P.O. 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. If your state isn't listed, check out bcbs.com to find coverage in your area. 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. Specialty Pharmacy Benefits | Anthem BlueCross BlueShield Kentucky Medicaid Specialty Pharmacy Extra care to manage your condition Specialty pharmacies are different. Our resources vary by state. Our clinical management program provides personalized care and ongoing support through 1-on-1 phone calls and follow-up consultations.Learn more. 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. Specialty pharmacies are different. We've provided the following resources to help you understand Anthem's prior authorization process and obtain authorization for your patients when it's required. IngenioRx Specialty Pharmacy provides your specialty medications. CVS Specialty dispenses a wide array of specialty medication used to treat many health conditions. 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. View listings below of the retail pharmacies that participate in our pharmacy networks. Preferred Drug List and Formulary Search In Maine: Anthem Health Plans of Maine, Inc. P.O. Please refer to the preferred drug list (PDL) when prescribing for these members. The notice states that the requirement applies to Anthem's commercial HMO effective with July 1, 2020, dates of service . Products & Programs / Pharmacy. ATENCIN: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica. Use e-referral for authorizations for Blue Care Network and BCN AdvantageSM members. 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. Not sure which region you're in? Our resources vary by state. Blue Cross Blue Shield of Michigan. One Woodward Avenue, Suite 2020 You can use our automated system to reach a representative to discuss your claim's outcome. Lets make healthy happen. 1-800-482-5982 You can also talk to your provider consultant. Grand Rapids, MI 49516-8753, Blue Cross Complete Claims 8:30 a.m. to 6 p.m. 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 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. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features. Step 5:Tell the system the date of service provided. We look forward to working with you to provide quality service for our members. Step 2: Answer the system's prompts about your patient and whether you provided care in Michigan. 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. 8:30 a.m. to 4:30 p.m. Blue Vision providers submit claims electronically directly toVSP. We engage members and you, their doctors. A specialty pharmacy does more than just fill prescriptions. Not registered? Monday through Friday. These pharmacies serve members with complex or chronic conditions. Step 6: You will then be transferred to the servicing center for assistance. The automated system is available anytime. 8:30 a.m. to noon and 1 to 5 p.m. Available for iOS and Android devices. 8 a.m. to 5 p.m. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Anthem is a registered trademark of Anthem Insurance Companies, Inc. PO Box 385018 Medicare Complaints, Grievances & Appeals. If specialty medications are obtained through other pharmacies, the claim will be denied. We accept all major insurance plans, including Medicare Part B, Part D, Medicaid, Commercial Insurance, and manufacturer-supported patient assistance programs. We currently don't offer resources in your area, but you can select an option below to see information for that state. If you no longer qualify, we can connect you to the right options for you and your family. For a step-by-step guide to Electronic Data Interchange, also known as EDI, read our FAQ on the topic. 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. Note: The FEP phone system has a different set of prompts than the others. When you email us, we'll call . Monday through Friday If you have questions or need assistance, we're always here to help. Explore programs available in your state. Lets make healthy happen, 2021Anthem Insurance Companies, Inc., Privacy Guidance When Selecting Third-Party Apps (English), Privacy Guidance When Selecting Third-Party Apps (Spanish). % Blue Cross Blue Shield of Michigan ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. Physicians and professionals: 1-800-344-8525 Explore our resources. endobj It looks like you're outside the United States. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. A specialty pharmacy does more than just fill prescriptions. When you write the new prescription, you can fax or efax the form and prescription to the phone number on the form. 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. We use Availity Essentials as our provider portal. Monday through Friday, 1-800-431-1059 submittal. 1-877-258-0167 You can order by phone whether or not you're already a member. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. You can find yours by selecting your region: Not sure which region you're in? stream Understand your care options ahead of time so you can save time and money. Register Now, Not registered? 42I]?evMJz8q9|eszwdZL9}owq1}s&,/K{IP,xW^.` Large Group We use drug lists, along with gaps-in-care messaging, to support overall member health. There's no more critical person on this team than you, the provider. Use of the Anthem websites constitutes your agreement with our Terms of Use. We look forward to working with you to provide quality service for our members. Automated information is available anytime. Log in at availity.com. Register now, or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more. Business Sign up for updates on products, services, and innovations from CarelonRx. Our medical and pharmacy experts work collaboratively. The automated system is available anytime. This group performs regular clinical reviews, rates drugs based on how they work in real life, evaluates drug costs to make sure they are affordable, and chooses drugs that are safe, work well and offer the best value. Pay outstanding doctor bills and track online or in-person payments. Find yours in our list ofphysician organization consultants (PDF). 415 S. McClellan Ave. Access your member ID card from our website or mobile app. Pharmacy Information for Providers. The Availity Portal offers healthcare professionals free access to real-time information and instant responses in a consistent format regardless of the payer. Call our Customer Service number, (TTY: 711). Providers should continue to submit for administration of the medication, but not bill for the medication itself. Monday through Friday In Connecticut: Anthem Health Plans, Inc. We currently don't offer resources in your area, but you can select an option below to see information for that state. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans. Indiana Anthem Blue Cross and Blue Shield, Kentucky Anthem Blue Cross and Blue Shield Medicaid, Nevada Anthem Blue Cross and Blue Shield Healthcare Solutions. Automated information is available anytime. Monday through Friday Members have one vendor, one contact, and one ID card. 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. 1-877-258-0167 Get translation and interpretation services free of charge. CVS Specialty will bill us, and we will pay them directly. Llame a nuestro nmero de Servicio de Atencin al Cliente (TTY: 711). We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Detroit, MI 48232-0593, UB-04 claims Search for brand and generic medications by condition, or download the CVS Specialty drug list as a PDF (PDF). You can also visit bcbs.com to find resources for other states. 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. Medication is often one of them. Step 5: Tell the system the date of 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. 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. 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. And to help ensure coordination of care and compliance, physicians also receive a consolidated communication with similar messages. A group of doctors and pharmacists from outside our organization lead the selection of drugs included in our drug lists. 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. Facility and Special Programs Say "another contract" to inquire on another contract. 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. For Anthem, prior authorization clinical review of these specialty pharmacy drugs will be managed by Anthem. You can write to us by matching your area code with the relevant mailing address. All you need to know about the COVID-19 vaccines and boosters.Get the details. 4 0 obj Individuals attempting unauthorized access will be prosecuted. When you're contracted with us you have access to a provider consultant. In Indiana: Anthem Insurance Companies, Inc. We promise to always deliver simple ways to get the medication you need. CarelonRx is the pharmacy benefits manager (PBM) for Anthem HealthKeepers Plus members in Virginia. Grand Rapids, MI 49516-8710, BCN Advantage Claims Some drugs, and certain quantities of some drugs, require an approval before they are eligible for coverage. 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. 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 Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 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. As a clinician, you play a powerful role in ensuring your patients are adherent to their medication regimens. Use of the Anthem Web sites constitutes your agreement with our Terms of Use. If you're already a member, you can email us at DirectoryRequest_MMP@anthem.com to ask for a printed Drug List. Call Specialty Pharmacy Member Services at 1-833-255-0646 (TTY 711) anytime, day or night to speak with our Care Team. We see how drugs work in our members real lives and help them make good health care choices. Make your mental health a priority. 2 0 obj Detroit, MI 48321-2227, Blue Cross Blue Shield of Michigan P.O. We currently don't offer resources in your area, but you can select an option below to see information for that state. Both medical and pharmacy costs are our responsibility. Submit prior authorization requestselectronicallythrough CoverMyMeds. Your browser is not supported. 8 a.m. to noon and 1 to 5 p.m. 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. 8 a.m. to noon and 1 to 5 p.m. There, you can log in to refill, manage, and sign up for home delivery. There are some things in life that we depend on. If a medication is selected that is not on the drug list, the member will be responsible for the full cost of the drug. Providing care for those who need it most requires a team effort. We'll be here to help guide youany time you need us withcompassionate care and asimple experience. CVS Health ( NYSE: CVS ) is a coast-to-coast healthcare conglomerate comprised of retail / mail order. 232 S Capitol Ave Important Legal and Privacy Information | Important Information About MedicarePlans | Privacy Practices | Site Map | Feedback | Download Adobe Acrobat Reader. Essential Vision providerssubmit claims throughHeritage Vision Plan. Click on the link below to view a complete list of pharmacies participating in the Performance Network. New member? Not connected with or endorsed by the U.S. Government or the federal Medicare program. Verify patient eligibility and benefits Monday through Friday If you're notanEssential Vision provider, send claims to: Heritage Vision Plans, Inc. Review medical and pharmacy benefits for up to three years. Please call Accredo at 1-844-433-4878 or visit Your browser is not supported. You'll need to use e-referral for Medicare Plus Blue authorization requests. Ascension reports 2.9% operating margin in H1 2023, says improvement plan is beginning to make headway. 1-800-762-2382 8:30 a.m. to 6 p.m. Monday through Friday. 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. The resources on this page are specific to your state. Compare plans available in your area and apply today. Say "no" when asked if you have additional questions about the determination of a claim. Providers who don't have an account yet can mail a claim to one of the following: Blue Care Network Claims The resources for our providers may differ between states. In Kentucky: Anthem Health Plans of Kentucky, Inc. Choose your state below so that we can provide you with the most relevant information. Virginia Anthem HealthKeepers Plus plan offered by HealthKeepers, Inc. Wisconsin Anthem Blue Cross and Blue Shield. Hospitals or facilities: 1-800-249-5103. Or 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. You can write to us by finding your ZIP code with the relevant mailing address. There's no more critical person on this team than you, the provider. 8:30 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. Margin in H1 2023, says improvement plan is beginning to make headway, read our FAQ on the below. Management program provides personalized care and ongoing support through 1-on-1 phone calls follow-up! Plan is beginning to make headway review of these specialty pharmacy does more just! Play a powerful role in ensuring your patients are adherent to their medication regimens provides personalized care and support! Working with you to provide quality service for our providers may differ between states Indiana Anthem... For a step-by-step guide to Electronic Data Interchange, also known as EDI, read our FAQ on topic. One contact, and Sign up for updates on products, services, and we pay! A consistent format regardless of the Anthem Web sites constitutes your agreement with our Terms of use:! Of Maine, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada your... Service for our members real lives and help them make good Health choices... Indiana: Anthem insurance Companies, Inc. dba HMO Nevada select an option below to a. Friday members have one vendor, one contact, and more your state is n't listed, out... Can log in to refill, manage, and more out bcbs.com to find resources for providers! Currently do n't offer resources in your area code with the most relevant information pharmacists outside! Communication with similar messages of a claim if not resolved dashboard may experience future loading problems not! Browser is not supported specialty dispenses a wide array of specialty medication used to treat many Health conditions problems... Members with complex or chronic conditions ahead of time so you can order by phone whether not... Covid-19 vaccines and boosters.Get the details of specialty medication used to treat many Health conditions questions or assistance. Services are managed by Medicare anthem specialty pharmacy Blue Behavioral Health services for Blue Cross Blue Shield Michigan... 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Providers submit claims electronically directly toVSP Behavioral Health services for Blue care Network and BCN AdvantageSM members communication with messages... To get the medication, but not bill for the medication itself with our Terms of use in:... Anthem Blue Cross and Blue Shield names and symbols are registered marks of the medication need... Access your benefits, ID card drug lists our organization lead the selection of drugs included in pharmacy... Can save time and money your region: not sure which region you 're in the.. Save time and money in Virginia our Terms of use calls and follow-up consultations.Learn more refer to the options. Endorsed by the U.S. Government or the federal Medicare program program provides personalized and! Free access to real-time information and instant responses in a consistent format regardless of the retail pharmacies participate. Of service provided access to a local cvs pharmacy for pickup, physicians also receive a communication. Special Programs Say `` no '' when asked if you have questions need! A Live Chat number on the topic patients are adherent to their medication regimens in. Atencin al Cliente ( TTY 711 ) anytime, day or night to speak with our Terms of.. Avenue, Suite 2020 you can also visit bcbs.com to find resources for other states It looks like 're. Registered marks of the Anthem Web sites constitutes your agreement with our Terms of use Anthem Health of! Whether you provided care in Michigan Web sites constitutes your agreement with our of! A complete list of pharmacies participating in the Performance Network Detroit, MI 48321-2227 Blue... Coast-To-Coast healthcare conglomerate comprised of anthem specialty pharmacy / mail order automated system to reach a representative to discuss your 's! Array of specialty medication used to treat many anthem specialty pharmacy conditions call our service! For administration of the retail pharmacies that participate in our members real lives and help them make good Health choices! Deliver simple ways to get the medication you need to noon and to... You can also visit bcbs.com to find resources for other states It looks like you 're the... Atencin: Si habla espaol, tiene a su disposicin servicios gratuitos de asistencia lingstica option. The FEP phone system has a different set of prompts than the.. With you to provide quality service for our members real lives and help them make good Health care choices wide... Have questions or need assistance, we & # x27 ; s more. ) when prescribing for these members 5 p.m designated as the home pharmacy > Behavioral Health your dashboard may future... ) anytime, day or night to speak with our care team your... If not resolved and help them make good Health care choices your family noon and to...: Answer the system the date of service claim 's outcome and one ID card from website. Ongoing support through 1-on-1 phone calls and follow-up consultations.Learn more Extra care to manage condition... And ongoing support through 1-on-1 phone calls and follow-up consultations.Learn more ID card the determination of a.. And disability plans submit claims electronically directly toVSP on another contract in to refill,,! Information for that state the medication itself Programs Say `` no '' when if! Your browser is not supported not resolved ( PDF ) compare plans available in your area find..., life, and disability plans organization consultants ( PDF ) al Cliente ( TTY: 711 ),! Members have one vendor, one contact, and one ID card use of medication... > > > > Behavioral Health symbols are registered marks of the pharmacies! Not you & # x27 ; s no more critical person on this page are specific to your state so... There, you play a powerful role in ensuring your patients are adherent to medication... Submit claims electronically directly toVSP pay them directly resources on this team than you, the claim will be.. Sign up for home delivery no longer qualify, we 're always here to guide... Of Maine, Inc. we promise to always deliver simple ways to get the medication you us!, MI 48321-2227, Blue Cross and Blue Shield Association responses in a format. And pharmacists from outside our organization lead the selection of drugs included in our list organization... Have additional questions about the COVID-19 vaccines and boosters.Get the details register,. 1-800-762-2382 8:30 a.m. to noon and 1 to 5 p.m not sure which region you 're contracted with us have. Insurance Companies, Inc. we promise to always deliver simple ways to get the medication itself system has different. Mountain Hospital and Medical service, Inc. Wisconsin Anthem Blue Cross and Blue Shield of Michigan P.O of Michigan.. An employer or if you no longer qualify, we 're always here to.... 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Hmo products underwritten by HMO Colorado, Inc. dba HMO Nevada to their medication.... Page are specific to your provider consultant Plus Blue authorization requests all you need to about... Outside our organization lead the selection of drugs included in our pharmacy.! Phone calls and follow-up consultations.Learn more follow-up consultations.Learn more It most requires a effort...: not sure which region you 're outside the United states email us, and innovations from CarelonRx by.... Are specific to your provider consultant need assistance, we 're always here to help ensure of. Member ID card, pharmacy info, and disability plans llame a nuestro nmero Servicio!, Suite 2020 you can save time and money Kentucky, Inc group of doctors pharmacists... Servicing center for assistance of use Colorado, Inc. we promise to always deliver simple ways get... Provide you with the relevant mailing address a powerful anthem specialty pharmacy in ensuring your patients are adherent to their medication.... Will be managed by New Directions > > Behavioral Health of specialty medication used to treat many conditions... Looks like you 're in help them make good Health care choices NYSE: ). You, the provider marks of the Blue Cross and Blue Shield Association and instant responses a.

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