Effective December 1, 2020, prior authorization (PA) requirements changed for HCPCS code 55899. This will be reviewed using MED.00132: Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures. This code will require PA by Anthem Blue Cross and Blue Shield for members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

PA requirements will be added to the following:

  • 55899 — Unlisted procedure, male genital system

 

To request PA, you may use one of the following methods:

  • Web: availity.com*
  • Fax:
    • Inpatient-new emergent: 1-866-406-2803
    • Inpatient-concurrent emergent/new urgent: 1-844-765-5156
    • Outpatient: 1-844-765-5157
  • Phone:
    • Hoosier Healthwise: 1-866-408-6132
    • Healthy Indiana Plan (HIP): 1-844-533-1995
    • Hoosier Care Connect: 1-844-284-1798

 

Not all PA requirements are listed here. PA requirements are available to providers by accessing the Precertification Lookup Tool at anthem.com/inmedicaiddoc > Provider Resources & Documents > Quick Tools or for contracted providers at availity.com. Providers may also call Provider Services for assistance with PA requirements.

 

Provider Services:

  • Hoosier Healthwise: 1-866-408-6132
  • HIP: 1-844-533-1995
  • Hoosier Care Connect: 1-844-284-1798

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.



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March 2021 Anthem Provider News - Indiana