Anthem Blue Cross Blue Shield

Indiana Providers

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

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

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 here.

* 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

Page Last Updated: 10/11/2021

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