Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. ICR offers a fast, efficient way to securely submit your requests with clinical documentation. You can also check status of an existing request and auto-authorize more than 40 common procedures. Providers are
responsible for verifying precertification requirements before services are rendered. You can use the Precertification Lookup Tool or reference the provider manual to determine if authorization is needed. We encourage providers to use ICR in Availity for all notifications or precertification requests, including reporting a member’s pregnancy. Need help with Availity?Precertification contactsPharmacyPrescription drugs, including specialty medications, some over-the-counter (OTC) medications and home infusion therapy solutions, are covered by ForwardHealth. ForwardHealth Provider ServicesPhone:800-947-9627 Website:www.forwardhealth.wi.gov Provider tools & resources
Interested in becoming a provider in the Anthem network?We look forward to working with you to provide quality services to our members. To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. Don’t have an Availity account?Need help with Availity?Behavioral healthServices billed with the following revenue codes ALWAYS require precertification:
PharmacyPharmacy prior authorizations can be requested through Availity. You can also request prior authorization by calling:Hours of operation: Monday-Friday, 8 a.m. to 8 p.m. Hoosier Healthwise:866-408-6132 Healthy Indiana Plan:844-533-1995 Hoosier Care Connect:844-284-1798 Fax:Retail:844-864-7860 Medical Injectables:888-209-7838 Services billed with the following revenue codes ALWAYS require precertification:
The following ALWAYS require precertification: Elective services provided by or arranged at nonparticipating facilities All services billed with the following revenue codes:
Prior authorization - PhoneUtilization Management, Behavioral Health and Pharmacy Hours of operation: Monday-Friday, 8 a.m. to 8 p.m. Hoosier Healthwise:866-408-6132 Healthy Indiana Plan:844-533-1995 Hoosier Care Connect:844-284-1798 Prior authorization - FaxPhysical health inpatient and outpatient services: Fax866-406-2803 Concurrent reviews for inpatient, skilled nursing facility, long-term acute care hospital and acute inpatient rehabilitation: Fax844-765-5156 Submission of clinical documentation as requested by the Anthem Blue Cross and Blue Shield outpatient Utilization Management department to complete medical necessity reviews for outpatient services such as DME, Home Health care, wound care, orthotics, and out-of-network requests should be faxed to 844-765-5157. For AIM-related CPT® codes, all requests are initiated by AIM Specialty Health®* online at https://aimspecialtyhealth.com or by calling 844-767-8158. You may also access the Precertification Lookup Tool directly here. * AIM Specialty Health is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield. Fax844-765-5157 Related resources
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Page Last Updated: 10/11/2021 Provider tools & resources
Interested in becoming a provider in our network?We look forward to working with you to provide quality services to our members. How do I submit a prior authorization to availity?How to access and use Availity Authorizations:. Log in to Availity.. Select Patient Registration menu option, choose Authorizations & Referrals, then Authorizations*. Select Payer BCBSOK, then choose your organization.. Select a Request Type and start request.. Review and submit your request.. Does Blue Cross Blue Shield of Michigan require prior authorization?BCBSM requires prior authorization for services or procedures that may be experimental, not always medically necessary, or over utilized. Providers must submit clinical documentation in writing explaining why the proposed procedure or service is medically necessary.
How long does it take Anthem to approve medication?After you ask and we get all of the information we need for medical services and items, we will notify you of our determination no later than 14 calendar days. If your request is for a Medicare Part B prescription drug, we will give you a decision no more than 72 hours after we receive your request.
What form do providers in California use to request prior authorization?Providers must request CCS services using a SAR form. Note: Providers should verify CCS eligibility before submitting a SAR. Providers are required to submit documentation to substantiate medical necessity at the time the SAR is submitted.
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Anthem blue cross blue shield prior authorization number
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