Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. Additionally, providers can use this tool to make inquiries on
previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). 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?Prior Authorization Contact InformationProviders and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal)
Utilization Management (UM) for Major Risk Medical Insurance Program (MRMIP)
Anthem Blue Cross Cal MediConnect Plan
PharmacyPharmacy Prior Authorization Center for Medi-Cal:
*For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Services requiring prior authorizationAnthem’s Prior Authorization Lookup Tool Online can assist with determining a code’s prior authorization requirements. You can also refer to the provider manual for information about services that require prior authorization.
Emergency medical servicesAnthem does not require prior authorization for treatment of emergency medical conditions. In the event of an emergency, members may access emergency services 24/7. In the event that the emergency room visit results in the member’s admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Related ResourcesProvider 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. The prior authorization list is a resource for providers that lists the designated medical and surgical services and select prescription drugs which require prior authorization under a Blue Shield of California Promise Health Plan medical benefit. This list also includes specific equipment, services, drugs, and procedures requiring review or supplemental documentation prior to payment authorization. Prior authorization for the services listed below is highly recommended. If authorization was not obtained prior to the service being rendered, the service will likely be reviewed for medical necessity at the point of claim. While the list below covers the medical services, drugs, and procedures that require authorization prior to rendering a service, Blue Shield Promise may require additional information after the service has been provided. If we require further information to process the payment, Blue Shield Promise’s Claims Department will request specific information at that time. Please include medical records when you respond to a request from Blue Shield Promise’s Claims Department. Please review our clinical policies and procedures and verify that any service you are going to provide a Blue Shield Promise member is a covered benefit. You may review our medical policies online or contact Provider Services at (800) 468-9935, 6 a.m. to 6:30 p.m., Monday through Friday. If prior authorization was obtained and you are submitting an offline (i.e., paper) claim, remember to attach a copy of the prior authorization letter. Prior Authorization Code ListsMedi-Cal/Cal
MediConnect Prior Auth Codes Medi-Cal/Cal MediConnect Prior Auth Code List - September 2022 (PDF, 407 KB) Medi-Cal/Cal MediConnect Prior Auth Code List - June 2022 (PDF, 386 KB) Medi-Cal/Cal MediConnect Prior Auth Code List - February 2022 (PDF, 586 KB) Medi-Cal/Cal MediConnect Prior Auth Code List - December 2021 (PDF, 570 KB) Medi-Cal/Cal MediConnect Prior Auth Code List - August 2021 (PDF, 483 KB) Prior authorization information for medications Prior Authorization information for medications can be found here for Medi-Cal plans. |
Blue cross blue shield of california prior authorization form
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