For information about services that need preapproval, please see your member handbook. If you need help contacting your case manager or care coordinator, call us at 1-800-901-0020 (Medallion Medicaid and FAMIS) or 1-855-323-4687 (CCC Plus); TTY 711. Or call Member Services at 1-800-901-0020 (Medallion Medicaid and FAMIS) or 1-855-323-4687 (CCC Plus); TTY 711. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 2021Anthem Insurance Companies, Inc. Assistive Devices and Walker/Wheelchair Accessories, Privacy Guidance When Selecting Third-Party Apps, Privacy Guidance When Selecting Third-Party Apps - Spanish, Having programs and services to help make sure the quality of health care you get is even better, Supporting pregnant members and new moms with tools and information, Finding local programs in your community to help you get the services you need, Hosting events to help you learn about your plan and get the most out of it, Looking at our quality reports to find new ways to offer better care, How we are working to make things better for you, Youve just gotten out of the hospital and need help with follow-up visits to other providers, Youre going to the emergency room (ER) often for nonurgent care that could be handled by your provider, You call our 24/7 NurseLine and need more follow-up for ongoing care, You have serious physical problems and need more help, You have behavioral health problems and need more help working with all of your providers, Getting referrals and prior authorizations (approvals). Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Provides participants with routine eye care. No referrals required for network specialist Through anthem.com, you can estimate the costs for inpatient and outpatient services and doctor visits. Anthem HealthKeepers Plus Provider Manual Cardinal Care referral directories CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Checking a member's plan of care. Theyve just gotten out of the hospital and need help with follow-up visits to other doctors. If youre not sure youre having an emergency, call the 24/7 NurseLine. We want to make sure you have the healthcare coverage you need. The resources for our providers may differ between states. When your annual out-of-pocket costs exceed $6,350. Were more than just a website and phone number. Find your care coordinator's phone number and email address. Always identify themselves with their name, title and position with your Anthem HealthKeepers Plus plan. Call HealthKeepers, Inc. Member Services at 1-800-901-0020 (Medallion Medicaid and FAMIS) or 1-855-323-4687 (CCC Plus); TTY 711. $2 ,000.00 maximum plan benefit . The resources for our providers may differ between states. Download from your app store and log in using the same username and password., 1-800-901-0020 For a listing of doctors in your Anthem HealthKeepers Plus plan, use our Find a Doctor tool . Because any representation of a clinical area of expertise is based on your self-disclosure and professional judgment, please only select those items that fall within the scope of your state-issued license and clinical experience. Looking for a form that isnt listed? As an Anthem HealthKeepers Plus member, you don't need a referral to see a provider who's not your PCP as long as the provider is listed as one of the doctors in your plan. Your browser is not supported. While extremely helpful in promoting your services, completion of the BHAEP does not affect your credentialing materials/status or provider contract. Become an Anthem provider and join the nation's second- largest health plan-owned behavioral health company, serving more than 13.8 million members. Without a proper referral, your medical services may not be covered, which means you might have to pay more. Talk with teens about any private health issues. If your state isn't listed, check out bcbs.com to find coverage in your area. Anthem HealthKeepers Plus extra programs and services: More than 25,000 providers statewide No-cost over-the-counter medications (when prescribed by doctors) Routine eye exams for all members, and glasses or contacts (ages 20 and under) . If these changes offer the same or better results than what is used today. Referrals Please call our Case Management team to refer a member or learn more about our programs. It may be time to renew your health benefits. Sign up at no cost on theLiveHealth Online website or download the free app: * Prescriptions determined to be a controlled substance (as defined by the Controlled Substances Act under federal law) cannot be prescribed using LiveHealth Online. You and your loved ones can stay protected by going for a flu vaccine. Online visits using LiveHealth Online are a covered benefit under your Anthem health plan. Find frequently used forms, training resources, manuals and guides, prior authorization information, referral information, and other support. You'll also typically pay less when visiting a PCP instead of a specialist.The Anthem HealthKeepers network includes many doctors and hospitals across Not all plans offer all of these benefits. HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. 1-800-901-0020 (TTY 711) Health issues can come up when you least expect them. Find frequently used forms, training resources, manuals and guides, prior authorization information, referral information, and other support. Keycare Enhanced and KeyCare Core use the same PPO network and do not require referrals to specialists. Anthem Silver Pathway X 6550 HMO - Healthcare Status Note: All types of Medicaid now renew during the regional period. Your patients may already be working with one of our case managers. Please contact Medicare.gov or 1-800- MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options. Health care can be overwhelming. True emergency care . We can talk to you about: We can also send you information on our Quality Management program. 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. . HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Certain pharmacies offer flu vaccines by walk-in or appointment. Select a State Prior Authorization Health insurance can be complicatedespecially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). If not, or if they need help contacting their case manager, please have them contact We can connect you to a plan thats right for you. Our case managers and care coordinators can help make it easier. We work hard to make sure you can get great care when you need it. Do you need a printed copy of your member handbook? If you want to switch to the Anthem HealthKeepers Plus plan, Learn more.. This includes providers for physical and behavioral health. Here are some frequently asked questions: Flu season runs from October through May. PDF Your Anthem HealthKeepers Plan - Thomas Jefferson National Accelerator You dont need a referral from your primary care provider (PCP) to see a behavioral health specialist in your plan. They have serious physical problems and need more help managing their health. Anthem HealthKeepers 01617VAMEN 2/10 (continues on reverse) Care is guided by your doctor who will also coordinate referrals for specialist care. CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). Your healthcare needs dont always follow a schedule. HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. For prescription drug on formulary at in-network pharmacy. Choose your state below so that we can provide you with the most relevant information. If you or a family member are having these kinds of problems, you can get help. We are here to help. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. 2021Anthem Insurance Companies, Inc. Stay informed activate your online account. Member Services at 1-800-901-0020 (Medallion Medicaid and FAMIS) or 1-855-323-4687 (CCC Plus); TTY 711. Summary of Benefits and Coverage - Anthem $10.35 copay or 5% (whichever costs more), Diagnostic radiology services (e.g., MRI), Prosthodontics, other oral/maxillofacial surgery, other services, Outpatient group therapy visit with a psychiatrist, Outpatient individual therapy visit with a psychiatrist, Physical therapy and speech and language therapy visit, Durable medical equipment (e.g., wheelchairs, oxygen), Prosthetics (e.g., braces, artificial limbs). In Virginia, we: *According to NCQAs Medicaid Health Plan Accreditation Advertising and Marketing Guidelines 2020. The Medicare plans represented are PDP, HMO, PPO or PFFS plans with a Medicare contract. . HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. We encourage providers to use We currently don't offer resources in your area, but you can select an option below to see information for that state. The mission is to offer education, a wide range of targeted interventions and enhanced access to care to ensure improved outcomes and quality of life for members. Keycare Enhanced and KeyCare Core use the same PPO network and do not require referrals to specialists. Were here to help, too. You can change your PCP or behavioral health provider at any time. LiveHealth Online lets you visit a doctor through live video on your computer, tablet, or smartphone. If you have questions, ALEX has the answers. Please use the They call our 24-hour Nurse HelpLine and need more follow-up for ongoing care. Hearing Benefits. Enrollment in plans depends on contract renewal. PDF Your Health Care Plan They or you, their healthcare provider, thinks case management might help the member. It is recommended for those ages 6 months and older by the Centers for Disease Control and Prevention. We currently don't offer resources in your area, but you can select an option below to see information for that state. Benefits may vary by carrier and location. Start by asking your current PCP or behavioral health provider for a recommendation for a new adult PCP or behavioral health provider. HMO, POS, PPO, and HDHP: Making Sense of Different Types of Health Plans Have a fever over 100.5 degrees Fahrenheit. Member Services. How to Choose a Health Insurance Plan | Anthem Anthem Enhanced Choice Health Insurance | Anthem What is a prior approval? With ICR, you can submit or check status of a request, attach clinical documentation and auto-authorize more than 40 common procedures. $0.00 Monthly Premium If you think the problem is so severe it may be life-threatening or cause serious damage, call 911 or go to the nearest hospital emergency room (ER). Your PCP will tell you what to do. Overall Health Plan Rating ( 4 out of 5) Staying Healthy: Screenings, Tests and. Your dashboard may experience future loading problems if not resolved. It looks like you're in . Choose your location to get started. Manage your health on-the-go with useful apps, Assistive Devices and Walker/Wheelchair Accessories, Privacy Guidance When Selecting Third-Party Apps, Privacy Guidance When Selecting Third-Party Apps - Spanish. What does it cost? Referrals and Prior Approvals | Anthem HealthKeepers Plus Virginia Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical . Setting up healthcare services for the member. The prescription plan is the same for all Anthem health insurance plans. Advise you on where to go when you need care. The toll-free 24/7 NurseLine lets you talk with a registered nurse whenever you have health questions or need medical advice day or night, holidays, and weekends. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Depending on the type of vaccine you get, you will need one or two doses to ensure you are protected from COVID-19. The ER doesnt have your medical records. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Behavioral health benefits are integrated into Anthemmedical plans for a full spectrum of coordinated care for our members. HealthKeepers, Inc. makes medical necessity determinations for select inpatient, outpatient, pharmacy and major diagnostic procedures. Fax medical prior authorization request forms to: 844-864-7853 You can also find a provider by viewing the provider directory. It's quick and easy to sign up and get started. Get key information on covered services, utilization management, clinical guidelines, health services programs, claims procedures and reimbursement policies. Cost. For some services, you may need a referral from your child's primary care provider (PCP) or prior authorization (that means you ask us at HealthKeepers, Inc. for an OK . We look forward to working with you to provide quality service for our members. We look forward to working with you to provide quality service for our members. There are four vaccines available now. You can get the name of a behavioral health specialist who will see you if you need one. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. Employees who work at least 17 1/2 hours per week are eligible (PWCS health insurance regulation). Their advantages: An HMO typically has lower monthly payments and out-of-pocket costs. ET | TTY #711. Cardinal Care | Anthem HealthKeepers Plus Virginia Medicaid Spend as much or as little time as you like, at your convenience. Will it work? As an Anthem HealthKeepers Plus member, you have rights and responsibilities. 1-800-901-0020 LiveHealth Online is the trade name of Health Management Corporation, a separate company providing telehealth services on behalf of the Anthem HealthKeepers Plus plan. Provider search tool For detailed information on coordinating patient referrals, please see our provider manual. They have behavioral health problems and need more help working with all their doctors. HealthKeepers, Inc. is committed to supporting you in providing quality care and services to the members in our network. ET, Sat Sun 10a.m. 7p.m. Behavioral health benefits are integrated into Anthem medical plans for a full spectrum of coordinated care for our members. PDF Your Anthem HealthKeepers - Capitol Group Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. You can also visit bcbs.com to find resources for other states It looks like you're outside the United States. Note: All types of Medicaid now renew during the regional period. PDF Summary of Benefits and Coverage - Prince William County Government This plan covers 1 routine hearing exam (s) and hearing aid fitting/evaluation (s) every year. We currently don't offer resources in your area, but you can select an option below to see information for that state. The integration of physical and behavioral health is core to members holistic care management. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Prescription . PDF Your Open Access Plan - eHealth Get detailed information on coordinating referrals to a PCP, specialist, facility or pharmacy in a members plan. Dermatologist that Accepts Anthem | U.S. Dermatology Partners Access training and tutorials offered by HealthKeepers, Inc. that support providers in caring for our members and continuing their education. You may already be working with a case manager or care coordinator and know how to contact them. HealthKeepers, Inc. works collaboratively with hospitals, group practices and independent behavioral healthcare providers, as well as community agencies, Virginia's Community Services Boards and other resources to successfully meet the behavioral health needs of members. We do not offer every plan available in your area. Your benefits include many medically needed services, such as: See your member handbook, to learn more about your benefits. To help you stay enrolled, please keep these open enrollment dates in mind. Central region: April 19 - June 30. Setting up healthcare services for the member. For children under age 19 with working parents who may not qualify for Medicaid. There is no cost for anyone to receive a vaccine.. Log in to the Employee Self Service (ESS) to enroll in Medical Dental and Vision plans. Anthem Medical Insurance Information - Prince William County Public Schools You can contact IngenioRx at 1-833-419-0530 or help@igneio-rx.com. We can help you out. Your answers to the brief survey below will help our members find the right behavioral health provider to fit their unique needs. Healthcare Effectiveness Data and Information Set (HEDIS), Early and Periodic Screening, Diagnostic and Treatment (EPSDT). The BHAEP is designed to highlight your services, cultural preferences, race, languages spoken, and specialties to our members through the enhancement of our online provider directory. Expedited fax: 888-235-8390. Limitations and exclusions may apply. What better way to help you determine what to do? Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Become an Anthem provider and join the nations second- largest health plan-owned behavioral health company, serving more than 13.8 million members. To help you stay enrolled, please keep these open enrollment dates in mind. Availability of TTY Services and Foreign Language Interpretation when Prospective Members Call the Drug Plan, Member Complaints and Changes in the Drug Plan's Performance, Complaints about the Drug Plan (More Stars Are Better because It Means Fewer Complaints), Improvement (if Any) in the Drug Plan's Performance, Ease of Getting Prescriptions Filled when Using the Plan, Plan Provides Accurate Drug Pricing Information for Medicare's Plan Finder Website, Taking Blood Pressure Medication as Directed, Taking Cholesterol Medication as Directed, Members Who Had a Pharmacist (or Other Health Professional) Help Them Understand and Manage Their Medications, The Plan Makes Sure Members with Diabetes Take the Most Effective Drugs to Treat High Cholesterol, Mon Fri 7a.m. 10 p.m. Call 1-800-901-0020 if youre a Medallion Medicaid or FAMIS member or 1-855-323-4687 if youre a CCC Plus member; TTY 711. PDF Prior authorization requirement changes updated - Anthem Provider You can also check status of an existing request and auto-authorize more than 40 common procedures. Availity, LLC is an independent company providing administrative support services on behalf of HealthKeepers, Inc. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). For specialty services you can coordinate yourself, you also need to use Anthem HealthKeepers network doctors, hospitals and other health care professionals or the services may not be covered. 1-800-901-0020 (TTY 711) . For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. Thats what our case managers and care coordinators do. Give you advice about caring for your baby if youre a new parent, like what to do if your baby has a fever, breastfeeding advice, and more. Behavioral Health Areas of Expertise Profile (BHAEP) Get the mobile app The notice follows the Privacy Rule set by the Health Insurance Portability and Accountability Act (HIPAA). We recommend you submit prior authorization requests via Interactive Care Reviewer (ICR), a secure Utilization Management tool available in Availity. Anthem MediBlue Dual Advantage (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Anthem HealthKeepers Plan ID: H3447-030-000 * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. As an adult, you can choose to change from a provider who specializes in care for children or teens to a provider who focuses on treating adults. If youre already our member, you dont have to do anything to stay with us. What to Consider When Shopping for Medicare, $285 per day for days 1 through 6 / $0 per day for days 7 through 90, $300 per day for days 1 through 5 / $0 per day for days 6 through 90, $0 per day for days 1 through 20 / $196 per day for days 21 through 100, Best Continuing Care Retirement Community (CCRC), Best Medicare Advantage Plan Companies 2023, Best Medicare Part D Prescription Drug Plan Companies 2023, Medicare Advantage Plus Prescription Drug Plans in Virginia, Medicare Advantage Plus Prescription Drug Plans in 23304 (Isle of Wight County), Anthem HealthKeepers Medicare Advantage Plus Prescription Drug Plans in Virginia, Find Continuing Care Retirement Communites. Know your members options. HealthKeepers, Inc. is committed to supporting you in providing quality care and services to the members in our network. Virginia Medicaid Pediatric Behavioral Services, Behavioral Health Interactive Care Reviewer (ICR) Presentation, Behavioral Health Clinical Practice Guidelines, Child Community Mental Health and Rehabilitation Services (CMHRS) UM Guideline, General Community Mental Health Rehabilitation Services (CMHRS) UM Guideline, Virginia Medicaid Peer Support Services UM Guideline, Screening for alcohol use disorder in high-prevalence demographics, Mood Disorder Questionnaire Bipolar Disorder Screening. Monthly Drug Premium *Included in Monthly Plan Premium. Your health is important to us. Visit our PharmacyInformation page for formulary information and pharmacy prior authorization forms. You do not need to bring a government-issued ID and cannot be turned away for not having ID. Talk to you about your health and how youre handling different parts of your life. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you. Not sure if you qualify? Video chat with a doctor 24/7 from your smartphone, tablet, or computer at no cost to you using LiveHealth Online. Referrals | HealthKeepers, Inc. - Anthem Provider Call Member Services at 1-800-901-0020 (Medallion Medicaid and FAMIS) or 1-855-323-4687 (CCC Plus); TTY 711. Choose your location to get started. We look forward to working with you to provide quality service for our members. If you have vision loss or you need your child's Anthem HealthKeepers Plus written materials in an alternate format, call Member Services at . $30 reimbursement allowance for out-of-network vision exam. Just go to LiveHealthOnline.com or download the mobile app. * The above cost-sharing only applies to some drugs on this tier. If you are pregnant, it could mean harm to the health of you or your unborn baby. Forms | HealthKeepers, Inc. - Anthem Provider Your Care Plan is an online tool to help you: Stay connected with your care coordinator. Getting referrals and prior authorizations. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees. Welcome to Anthem HealthKeepers Open Access Your Anthem HealthKeepers Open Access plan gives you: coverage for important health care services including: checkups and sick visits labs, x-rays and other types of tests specialist services with no referrals required emergency and urgent care annual routine eye exams It also tells you how to get this data. PDF Member Handbook and Evidence of Coverage - Anthem Find a Dermatology Office That Accepts Anthem Near You With our extensive network of providers throughout Arizona , Colorado , Kansas , Maryland , Missouri , Oklahoma , Texas, and Virginia , there's a U.S. Dermatology Partners practice near where you live or work. Referrals. Healthkeepers HMO costs the least in premiums of the three Anthem plans but requires the use of a designated primary care physician (PCP) from the Healthkeepers network and referrals from your PCP to see a specialist. Your case manager or care coordinator works with you and your provider to set up a plan of care. We do this by: Have questions about the Quality Management program? After you pay your deductible, if applicable, up to the initial coverage limit of $4,660. You can also find a provider by viewing the provider directory. All new PWCS employees will enroll in health, dental, and vision benefits electronically coincident with their seated start date. Provider search tool Use our provider search tool for referring Anthem HealthKeepers Plus members to a PCP, specialist, facility, or pharmacy in their plan. 2020 copyright of Anthem Insurance Companies, Inc. HealthKeepers, Inc. is an independent licensee of the Blue Cross and Blue Shield Association. Page 2 of 11 for some services (such as lab work).
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