anthem blue cross prior authorization form radiology Anthem forms

Anthem blue cross prior authorization form radiology

Please verify benefit coverage prior to rendering services. Inpatient services and nonparticipating providers always require prior authorization. 

Please note:

  1. This tool is for outpatient services only.
  2. Inpatient services and nonparticipating providers always require prior authorization.
  3. This tool does not reflect benefits coverage* nor does it include an exhaustive listing of all noncovered services (in other words, experimental procedures, cosmetic surgery, etc.)— refer to your provider manual for coverage/limitations.

Enhanced Care Management (ECM) under CalAIM is a care management benefit that is community-based and provides a whole person approach to care that addresses the clinical and nonclinical needs of members with the most complex medical and social needs. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections.

Community Supports under CalAIM are voluntary wrap-around services or settings available to members as a substitute for utilization of other services that focus on medical and/or needs that arise from social determinants of health. Prior authorization requirements and coverage may vary from standard membership and will be documented in additional information sections.

* Services may be listed as requiring precertification (prior authorization) that may not be covered benefits for a particular member. Please verify benefit coverage prior to rendering services.

To determine coverage of a particular service or procedure for a specific member:

  • Access eligibility and benefits information on the Availity Web Portal or
  • Use the Prior Authorization Lookup Tool within Availity or
  • Contact the Customer Care Center:
    • Outside Los Angeles County: 1-800-407-4627
    • Inside Los Angeles County: 1-888-285-7801
    • Customer Care Center hours are Monday to Friday 7 a.m. to 7 p.m. 
    • After hours, verify member eligibility by calling the 24/7 NurseLine at 1-800-224-0336.

Customer Care Center

Monday to Friday, 7 a.m. to 7 p.m.

Outside Los Angeles County:

1-800-407-4627

Inside Los Angeles County:

1-888-285-7801

After hours, call the 24/7 NurseLine to verify member eligibility:

Phone:

1-800-224-0336

To request authorizations:

  1. From the Availity homepage, select Patient Registration from the top navigation. 
  2. Select Auth/Referral Inquiry or Authorizations.

Provider tools & resources

    • Log in to Availity
    • Learn about Availity
    • Prior Authorization Lookup Tool
    • Prior Authorization Requirements
    • Claims Overview
    • Reimbursement Policies
    • Provider Manuals, Policies & Guidelines
    • Referrals
    • Forms
    • Provider Training Academy
    • Pharmacy Information
    • Provider News & Announcements

    Interested in becoming a provider in the Anthem network?

    We look forward to working with you to provide quality services to our members.

    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. 

    Services requiring precertification

    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. 

    • Anthem Provider Manual

    Request precertification

    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 contacts

    Pharmacy

    Prescription drugs, including specialty medications, some over-the-counter (OTC) medications and home infusion therapy solutions, are covered by ForwardHealth.

    ForwardHealth Provider Services

    Phone:

    800-947-9627
    TTY: 711

    Website:

    www.forwardhealth.wi.gov

    Provider tools & resources

      • Log in to Availity
      • Learn About Availity
      • Precertification Lookup Tool
      • Precertification Requirements
      • Claims Overview
      • Member Eligibility & Benefits Overview
      • Policies, Guidelines & Manuals
      • Referrals
      • Forms
      • Provider Training Academy
      • Electronic Data Interchange (EDI)

      Interested in becoming a provider in the Anthem network?

      We look forward to working with you to provide quality services to our members.

      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.

      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 is the provider phone number for Anthem BCBS of Ohio?

      By Phone: Call the number on the back of the member's ID card or dial 800-676-BLUE (2583) to speak to a Provider Service representative.

      What is the fax number for Anthem Blue Cross of California?

      Phone: Call 1‑888‑831‑2246, option 3 and ask for a form to be faxed to you. Fax: Send your request to: 1-800-754-4708. Anthem Blue Cross is the trade name of Blue Cross of California.

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