Transcript Prior Authorization - indianamedicaid.com

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Second level
Third level
Anthem Serving Hoosier Healthwise
Fourth level
Healthy Indiana Plan
Fifth level
and
State Sponsored Business
Prior Authorization
Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee 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.
Prior Authorization
• Physician is responsible for obtaining the preservice review for
both professional and institutional services.
• Hospital and ancillary providers should always contact us to
verify preservice review status.
• Authorization is not required when referring a member to an in
network specialist.
• Authorization is required when referring to an out-of-network
specialist.
• Nonparticipating providers seeing Anthem’s Medicaid members
- All services require Prior Authorization.
• Check the Prior Authorization list regularly for any updates on
services that require Prior Authorization.
• See the Prior Authorization Toolkit listed on our website:
www.anthem.com
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Prior Authorization
Contact Information:
• Phone:
• FAX:
1-866-408-7187
1-866-406-2803
• Form and Resource Tools available online:
www.anthem.com
Providers SpotlightAnthem State Sponsored ProgramsINPolicies or Prior Auth
• Forms: Preservice Review Forms available, such as: Request for Preservice
Review; Home Apnea Monitor; Home Oxygen; CPAP/BIPAP; Pediatric Formula;
etc. See our website:
• Medical Policies and UM Clinical Guidelines.
Note: Requests that do not appear to meet criteria are sent to an Anthem
physician for medical necessity determination,
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Prior Authorization
What to have ready when calling Utilization Management:
• Member name and ID number
• Diagnosis with ICD9 code
• Procedure with CPT code
• Date(s) of Service
• Primary Physician, Specialist, and Facility performing services
• Clinical information to support the request
• Treatment and discharge plans (if known)
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Prior Authorization
Other Help Available:
• Retro Prior Authorization Review: If the service/care has already
been performed, UM case will not be started. Send medical
records in with the claim for review:
Attn: Anthem Correspondence/Utilization Management
Anthem Blue Cross and Blue Shield
PO Box 6144
Indianapolis, IN 46206-6144
• Benefits, Eligibility, or Claim information:
Hoosier Healthwise Contact Customer Care at 1-866-408-6132.
Healthy Indiana Plan Contact Customer Care at 1-800-553-2019.
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Prior Authorization
Time Frames:
• Non-urgent reviews are completed within 14 calendar days from
date of request.
• Urgent reviews are completed within 72 hours from the date of
the request.
• Emergency services do not require prior authorization.
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Prior Authorization
Questions
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