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Anthem Health Maintenance Organization (HMO)

PW_AD090985
Plan & Administrative Changes/Updates:  
Click here for important Medicare Advantage updates! 

Anthem Senior Advantage, SureValue and MediBlue HMO are Medicare Advantage HMO health plans offered within a select service area that features all of the health coverage services offered by Medicare, plus some extra services Medicare does not offer, such as annual physical exam, vision services – including eyewear, preventative dental services and fitness center membership, see the 2012 Summary of Benefits / 2013 Summary of Benefits

 

Members must seek non-emergency care from provider network, see Provider Finder

 

Authorization requirement apply for specific services. See Summary of Benefits for pre-authorization details.

 

FAST TRACK APPEALS
Medicare beneficiaries and providers have certain rights and protections related to financial liability under the Medicare Advantage (MA) Programs. Financial liability, appeal rights, and protections are communicated to beneficiaries through notices given by providers or the MA health plan. To download the forms click here.

Institutional billing codes are available from the NUBC via the NUBC's Official UB-04 Data Specifications Manual. To be redirected to NUBC click here

Additional Information

Medicare Advantage Out of Network Payment Guide

ID cards

Independent Provider Payment Dispute Process

Medicare Advantage HMO & PPO Provider Guidebook
(Formerly know as the Medicare Advantage HMO & PPO Provider Manual)

Medicare Coverage Homepage

Medicare Part D Coverage Determination Request Form (for use by provider)

Affordable Care Act (ACA)
Formerly known as Patient Protection and Affordable Care Act

Precertification Requirements

*Medicare Advantage Products never require Pre-Existing Condition signoff

Precertification Form

Preventive Health Guidelines

Quick Reference Guide to the CMS 1500

Revision of Definition of Compendium in the Medicare Benefit Policy Manual; Chapter 15; Section 50.4.5

 
Anthem encourages our providers to participate in the CMS and HHS quality improvement initiatives. To learn more about these initiatives or find new announcements, please visit http://www.cms.hhs.gov/home/medicare.asp and scroll to the bottom of the page under the section “Browse by Special Topic.” 
 
We want you to be sure you have no reservations about providing services to our members. We invite you to learn more about Anthem HMO. 
 
©2005-2014 copyright of Anthem Insurance Companies, Inc.

Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. 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. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use