Anthem blue cross blue shield prior authorization

© 2021 Anthem Insurance Companies, Inc.

Anthem Blue Cross is the trade name of Blue Cross of California and Anthem Blue Cross Partnership Plan is the trade name of Blue Cross of California Partnership Plan, Inc. Independent licensees of the Blue Cross Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross name and symbol are registered marks of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County.

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.

Behavioral health

Services billed with the following revenue codes ALWAYS require precertification:

Hoosier Healthwise:

866-408-6132

Healthy Indiana Plan:

844-533-1995

Hoosier Care Connect:

844-284-1798

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:

Hoosier Healthwise:

866-408-6132

Healthy Indiana Plan:

844-533-1995

Hoosier Care Connect:

844-284-1798

Prior authorization - Fax

Physical health inpatient and outpatient services:

Fax

866-406-2803

Concurrent reviews for inpatient, skilled nursing facility, long-term acute care hospital and acute inpatient rehabilitation:

Fax

844-765-5156

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.

Fax

844-765-5157

Related resources

• Medical Policies and Clinical UM Guidelines Search
• AIM Specialty Health Guidelines
• Universal Authorization Form

Documents

• DME Rental List
• Medical Necessity Code List
• Retail Pharmacy Prior Authorization Forms
• Medical Injectable Prior Authorization Form
• Synagis Prior Authorization Form
• Submit prior authorizations online with Interactive Care Review
• Behavioral Health outpatient authorization process
• Home Health wound care update
• Indiana Medicaid Prior Authorization Requirements List

Page Last Updated: 10/11/2021

Provider tools & resources

• Log in to Availity
• Learn about Availity
• Precertification Lookup Tool
• Prior Authorization Requirements
• Claims Overview
• Member Eligibility & Pharmacy Overview
• Provider Manuals and Guides
• Referrals
• Forms
• Training Academy
• Pharmacy Benefits
• Electronic Data Interchange (EDI)