Ready Reference Guide - Wisconsin Anthem BlueCross and ...
Ready Reference Guide - Wisconsin Anthem BlueCross and ...
Ready Reference Guide - Wisconsin Anthem BlueCross and ...
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Products<br />
Blue Access®<br />
Blue Preferred®<br />
Blue Preferred® Plus POS<br />
Blue Traditional®<br />
Blue Priority Plus POS<br />
Blue Access PPO<br />
(<strong>Anthem</strong> Associates)<br />
(1)<br />
(1)<br />
Product Available in SE WI<br />
effective 11-1-12 with Blue Priority<br />
Network in WI<br />
Lumenos Consumer Driven<br />
Health Plan (CDHP)<br />
HRA, HSA, HIA, HIA Plus<br />
Available in SE WI effective<br />
11-1-12 with Blue Priority Network<br />
Health Reimbursement Account<br />
(HRA)<br />
(<strong>Anthem</strong> Associates)<br />
Provider/Customer<br />
Service<br />
<strong>Anthem</strong> ID card<br />
See back of member<br />
(Back of card indicates "Benefits ID card<br />
administered by BCBS of<br />
WI...")<br />
Eligibility 800-676-BLUE (2583)<br />
BlueCard Provider Service 866-791-2292<br />
Provider Finder (BlueCard® 800-810-BLUE (2583)<br />
Network)<br />
Note: Please use the contacts referenced above for Non-<br />
WI Blue Medicare Advantage PPO members.<br />
Federal Employee Program<br />
(FEP)<br />
Group <strong>and</strong><br />
Individual Policies:<br />
888-571-9055<br />
Alpha-<br />
Prefixes<br />
Information<br />
Available on<br />
Availity ®<br />
866-791-2292 WUK Eligibility, Remits,<br />
Benefits,<br />
Claim Status, Claim<br />
Line Item Details,<br />
Secure Messaging<br />
800-972-6359 VZZ Eligibility, Remits,<br />
Benefits,<br />
Claim Status, Claim<br />
Line Item Details,<br />
Secure Messaging<br />
877-875-1223 WLU Eligibility, Remits,<br />
Benefits,<br />
Claim Status, Claim<br />
Line Item Details,<br />
Secure Messaging<br />
800-242-9635<br />
IVR: claim status,<br />
checks, remits,<br />
eligibility, benefits<br />
VZF, VZG,<br />
AYU<br />
VZR, VZT,<br />
AUJ, AYX<br />
VZD<br />
VZW<br />
Refer to<br />
Member's ID<br />
Card<br />
Eligibility, Remits,<br />
Benefits,<br />
Claim Status, Claim<br />
Line Item Details,<br />
Secure Messaging<br />
R Eligibility , Benefits,<br />
Claims, Remits,<br />
Secure Messaging<br />
<strong>Ready</strong> <strong>Reference</strong> <strong>Guide</strong> - <strong>Wisconsin</strong><br />
<strong>Anthem</strong> <strong>BlueCross</strong> <strong>and</strong> BlueShield - Revised 12/15/2012<br />
Claims Address<br />
<strong>Anthem</strong> Products<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
(Back of ID card indicates submit claims<br />
to BCBS plan in state where services<br />
rendered)<br />
Provider Adjustment Requests<br />
(Claim Reconsiderations)<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
BlueCard® (Non-<strong>Wisconsin</strong> Commercial <strong>and</strong> Medicare Advantage Blue Cross <strong>and</strong> Blue Shield Members' Plans )<br />
Refer to<br />
Member's ID<br />
Card<br />
Eligibility, Remits,<br />
Benefits,<br />
Claim Status, Claim<br />
Line Item Details,<br />
Secure Messaging<br />
Information dependent<br />
upon availability from<br />
Blue Plan's front-end<br />
system<br />
<strong>Anthem</strong> Lumenos Consumer Driven Health Plans (CDHP)<br />
Self-Funded Groups - Administered by <strong>Anthem</strong><br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
Federal Employee Program (FEP)<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
(Send requested medical records with a<br />
copy of the request letter on top to this<br />
address.)<br />
Utilization Management (UM)<br />
(Precertification of services not<br />
Provider Refunds<br />
managed by AIM Specialty Health<br />
(Contact Customer Service for<br />
the address for returning<br />
<strong>Anthem</strong> checks)<br />
SM<br />
<strong>and</strong> Case Management)<br />
Please listen carefully as the<br />
prompts have changed.<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance<br />
P.O. Box 73651<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance<br />
P.O. Box 73651<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance<br />
P.O. Box 73651<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance<br />
P.O. Box 73651<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance<br />
P.O. Box 73651<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance<br />
P.O. Box 73651<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
Same as claims address <strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance, P.O. Box 73651,<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
800-242-1527<br />
* Select the Medical Management<br />
Prompt for Precertification <strong>and</strong>/or<br />
Predetermination<br />
* Select Case Management for Care<br />
Coordination<br />
Fax: 866-959-2154<br />
UM Appeals: See pg 2<br />
888-896-8027<br />
* Select the Medical Management<br />
Prompt for Precertification <strong>and</strong>/or<br />
Predetermination<br />
* Select Case Management for Care<br />
Coordination<br />
866-398-1922<br />
* Select the Medical Management<br />
Prompt for Precertification <strong>and</strong>/or<br />
Predetermination<br />
* Select Case Management for Care<br />
Coordination<br />
Fax: 866-959-1394<br />
888-896-8027<br />
* Select the Medical Management<br />
Prompt for Precertification <strong>and</strong>/or<br />
Predetermination<br />
* Select Case Management for Care<br />
Coordination<br />
866-643-7087<br />
* Select the Medical Management<br />
Prompt for Precertification <strong>and</strong>/or<br />
Predetermination<br />
* Select Case Management for Care<br />
Coordination<br />
Fax: 866-959-2154<br />
Call the number on the back of the<br />
member's ID card<br />
Precert: 800-860-2156<br />
FAX: 800-732-8318<br />
Care Management: 800-711-2225<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield is the trade name of Blue Cross Blue Shield of <strong>Wisconsin</strong> ("BCBSWi") which underwrites or administers the PPO <strong>and</strong> indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") which underwrites or administers the HMO policies; <strong>and</strong> Compcare <strong>and</strong> BCBSWi collectively<br />
which underwrite or administer the POS policies. Independent licensees of the Blue Cross <strong>and</strong> Blue Shield Association. ® ANTHEM is a registered trademark of <strong>Anthem</strong> Insurance Companies, Inc. The Blue Cross <strong>and</strong> Blue Shield names <strong>and</strong> symbols are registered marks of the Blue Cross <strong>and</strong> Blue Shield Association. Availity® is<br />
an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on.<br />
Last Revision 12.06.2012 kam Page 1 of 2
Products<br />
Provider/Customer<br />
Service<br />
Alpha-<br />
Prefixes<br />
Medicare Supplement Products 866-341-1053 VZQ, VZL,<br />
AUQ<br />
<strong>Anthem</strong> Medicare Preferred<br />
St<strong>and</strong>ard PPO<br />
2013 available in 24 <strong>Wisconsin</strong><br />
counties. Click on the link below to<br />
view more information:<br />
2013 WI Medicare Advantage<br />
Update Bulletin<br />
<strong>Anthem</strong> MediBlue Select HMO<br />
(Medicare Advantage)<br />
2013 Available in Kenosha,<br />
Milwaukee, Racine <strong>and</strong> Waukesha<br />
counties.<br />
See BlueCard section for non-WI<br />
Blue Medicare Advantage PPO<br />
member information.<br />
888-290-9160 (Option<br />
1) - Provider Service<br />
800-467-1199<br />
Customer Service<br />
888-290-9160 (Option<br />
1) - Provider Service<br />
800-467-1199<br />
Customer Service<br />
VZM<br />
VZP<br />
<strong>Ready</strong> <strong>Reference</strong> <strong>Guide</strong> - <strong>Wisconsin</strong><br />
<strong>Anthem</strong> <strong>BlueCross</strong> <strong>and</strong> BlueShield - Revised 12/15/2012<br />
Information<br />
Available on<br />
Availity ®<br />
Claims Address<br />
Senior Services<br />
Eligibility, Benefits <strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
Eligibility, Remits,<br />
Benefits,<br />
Claim Status, Claim<br />
Line Item Details,<br />
Secure Messaging<br />
Eligibility, Remits,<br />
Benefits,<br />
Claim Status, Claim<br />
Line Item Details,<br />
Secure Messaging<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105187<br />
Atlanta, GA 30348-5187<br />
Sleep Testing <strong>and</strong> Therapy<br />
Precertification 10.15.12<br />
Sleep Testing <strong>and</strong> Therapy<br />
Precertification<br />
Applicable Codes: www.<strong>Anthem</strong>.com><br />
Providers>WI>Precertification>Imaging<br />
<strong>and</strong> Specialty Services Tools>Sleep<br />
Management Precertification CPT Codes<br />
AIM Sleep Testing <strong>and</strong> Therapy Call<br />
Center<br />
Phone: 800-554-0580<br />
Hours: 7:30am-6:00pm CDT M-F<br />
For more information see our July<br />
"Special Edition" Network Update<br />
Newsletter<br />
Provider Adjustment Requests<br />
(Claim Reconsiderations)<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield<br />
P.O. Box 105557<br />
Atlanta, GA 30348-5557<br />
Other Information<br />
Request Prospective Precertification Online via: www.availity.com or AIM Specialty Health SM AIM Specialty Health<br />
website at www.aimspecialtyhealth.com<br />
Applicable Products <strong>and</strong> Services: www.anthem.com/Providers/WI/Precertification <strong>Guide</strong>lines<br />
AIM Web Help Desk: 800-252-2021<br />
SM Medical Management<br />
High Tech Imaging <strong>and</strong> Echocardiography<br />
Precertification<br />
Imaging <strong>and</strong> Echocardiography Precertification<br />
Applicable Alpha Prefixes <strong>and</strong> CPT Codes:<br />
www.anthem.com> Provider> WI> Precertification<br />
>Imaging <strong>and</strong> Specialty Services Tools>Imaging<br />
Services Precertification Alpha Prefix Listing AND<br />
Imaging <strong>and</strong> Echocardiography Pre-certification CPT<br />
Codes<br />
AIM Imaging <strong>and</strong> Echocardiography Call Center<br />
Phone: Number on back of member ID card or 800-<br />
554-0580<br />
Hours: 7:30am-6:00pm CDT M-F<br />
Outpatient Radiation Therapy<br />
Precertification 10.1.12<br />
Outpatient Radiation Therapy<br />
Precertification<br />
Applicable Codes: www.anthem.com><br />
Provider>WI>Precertification>Imaging<br />
<strong>and</strong> Specialty Services<br />
Tools>Radiation Therapy<br />
Precertification codes<br />
AIM Outpatient Radiation Therapy<br />
Call Center<br />
Phone: 800-554-0580<br />
Hours: 7:30am-6:00pm CDT M-F<br />
For more information see our June 29th<br />
Outpatient Radiation Therapy Services<br />
Rapid Update<br />
Specialty Pharmacy Precertification<br />
Specialty Pharmacy Precertification<br />
Applicable Drugs <strong>and</strong> Codes:<br />
ww.anthem.com><br />
Provider>WI>Precertification>Imaging<br />
<strong>and</strong> Specialty Services Tools>Specialty<br />
Pharmacy Precertification Drugs <strong>and</strong><br />
Codes<br />
AIM Specialty Pharmacy Call Center<br />
Phone: 866-582-2343<br />
FAX: 866-993-5966<br />
Hours: 7:30am-5:00pm CDT M-F<br />
Utilization Management (UM)<br />
(Precertification of services not<br />
Provider Refunds<br />
managed by AIM Specialty Health<br />
(Contact Customer Service for<br />
the address for returning<br />
<strong>Anthem</strong> checks)<br />
SM<br />
<strong>and</strong> Case Management)<br />
Please listen carefully as the<br />
prompts have changed.<br />
Send to the refund address<br />
indicated on the remittance<br />
advice<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance, P.O. Box 73651,<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
<strong>Anthem</strong><br />
Cost Containment Overpayment<br />
Avoidance<br />
P.O. Box 73651<br />
Clevel<strong>and</strong>, OH 44193-1177<br />
Not applicable<br />
Precertification<br />
866-797-9884, Option 1<br />
FAX: 866-959-1537<br />
Precertification<br />
866-797-9884, Option 1<br />
FAX: 866-959-1537<br />
<strong>Anthem</strong> Utilization Management Appeals<br />
Phone: 800-325-3377<br />
Fax: 888-859-3046*<br />
Mail additional information to:<br />
*<strong>Anthem</strong> UM Appeals<br />
Grievance & Appeals Department<br />
P.O. Box 105568<br />
Atlanta, GA 30348-5568<br />
*Send appeals related to utilization management denials <strong>and</strong> true grievances <strong>and</strong><br />
appeals to this address. Please do not use this address for complaints (claim<br />
reconsideration requests). See the <strong>Guide</strong> to Provider Complaints <strong>and</strong> Appeals<br />
posted on <strong>Anthem</strong>.com under the Communications menu <strong>and</strong> then Publications<br />
for more information.<br />
EDI Payor IDs: Professional - 00950; Facility - 00450<br />
www.<strong>Anthem</strong>.com/Providers/<strong>Wisconsin</strong>/log on to My<strong>Anthem</strong><br />
eBusiness Help Desk: 866-755-2680 (Call to reset My<strong>Anthem</strong> SM for Provider password or for assistance with technical difficulties) Change<br />
My<strong>Anthem</strong> site administrator by emailing central.eprovider.rep@anthem.com.<br />
Important Notice: On November 2, 2012, certain functionality was shut down on our legacy Provider Portal, My<strong>Anthem</strong> SM EDI Solutions Help Desk: 800-470-9630<br />
Email: edi.ent.support@anthem.com<br />
Electronic Data Interchange (EDI)<br />
Information Available Online: http://www.anthem.com/edi/ (Select WI & click enter)<br />
Secure Provider Portals<br />
www.availity.com<br />
. As of November 3, 2012,<br />
secure web portal access to Eligibility & Benefits Inquiry, Claim Status Inquiry <strong>and</strong> Secure Messaging is available exclusively through Availity®,<br />
our multi-payer portal solution.<br />
Phone: 800-Availity (800-282-4548) (Call for assistance with registration, Web-related questions <strong>and</strong> password reset)<br />
<strong>Anthem</strong> Blue Cross <strong>and</strong> Blue Shield is the trade name of Blue Cross Blue Shield of <strong>Wisconsin</strong> ("BCBSWi") which underwrites or administers the PPO <strong>and</strong> indemnity policies; Compcare Health Services Insurance Corporation ("Compcare") which underwrites or administers the HMO policies; <strong>and</strong> Compcare <strong>and</strong> BCBSWi collectively<br />
which underwrite or administer the POS policies. Independent licensees of the Blue Cross <strong>and</strong> Blue Shield Association. ® ANTHEM is a registered trademark of <strong>Anthem</strong> Insurance Companies, Inc. The Blue Cross <strong>and</strong> Blue Shield names <strong>and</strong> symbols are registered marks of the Blue Cross <strong>and</strong> Blue Shield Association. Availity® is<br />
an independent company providing a wide variety of online tools that allow providers to access real-time information from multiple payers via one secure sign-on.<br />
Last Revision 12.06.2012 kam Page 2 of 2
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