Prior Authorization and Claims overview

Filing your claims should be simple. That’s why Anthem Blue Cross and Blue Shield (Anthem) uses Availity, a secure and full-service web portal that offers a claims clearinghouse and real-time transactions at no charge to health care professionals. You can use Availity to submit and check the status of all your claims and much more at .

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Prior authorizations

Anthem makes determinations based on selected inpatient or outpatient medical services including surgeries, major diagnostic procedures, and referrals to validate medical necessity.


Electronic Data Interchange (EDI) is the computer-to-computer exchange of business documents in a structured format. EDI provides a faster and cleaner method for delivering time-dependent data, saving you time compared to filing paper claims.

Provider disputes

You have the right to request an appeal of a claim decision. You may request this appeal on your own behalf or on behalf of a covered Individual.

Reimbursement policies

Policies outline the basic terms for reimbursement of services covered under our members’ benefits plans and include definitions for terms used in the policies and disclaimer for the policies’ use.

Page Last Updated: 07/16/2021

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