Prior authorization requirements
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.
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Behavioral health
Services billed with the following revenue codes ALWAYS require precertification:
| 0240–0249 | All-inclusive ancillary psychiatric |
| 0901, 0905–0907, 0913 and 0917 | Behavioral health treatment services |
| 0944–0945 | Other therapeutic services |
| 0961 | Psychiatric professional fees |
Pharmacy
Pharmacy prior authorizations can be requested through Availity.
You can also request prior authorization by calling:
Hours of operation: Monday-Friday, 8 a.m. to 8 p.m.
Hoosier Healthwise:
866-408-6132
Healthy Indiana Plan:
844-533-1995
Hoosier Care Connect:
844-284-1798
Indiana PathWays for Aging
833-569-4739
Fax:
Retail:
844-864-7860
Medical Injectables:
888-209-7838
Services billed with the following revenue codes ALWAYS require precertification:
| 0632 | Pharmacy multiple sources |
The following ALWAYS require precertification:
Elective services provided by or arranged at nonparticipating facilities
All services billed with the following revenue codes:
| 0023 | Home health prospective payment system |
| 0570–0572, 0579 | Home health aid |
| 0944–0945 | Other therapeutic services |
| 3101–3109 | Adult day and foster care |
Prior authorization - Phone
Utilization Management, Behavioral Health and Pharmacy
Hours of operation: Monday-Friday, 8 a.m. to 8 p.m.
Hoosier Healthwise:
866-408-6132
Healthy Indiana Plan:
844-533-1995
Hoosier Care Connect:
844-284-1798
Indiana PathWays for Aging
833-569-4739
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.
* 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
Documents
Page Last Updated: 7/2/2024