Blue Cross Blue Shield of Kentucky

Providers - Kentucky

Prior Authorization Requirements


Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members.

Anthem Blue Cross and Blue Shield Medicaid (Anthem) is available via phone or the ICR 24 hours a day, 7 days a week to accept prior authorization (PA) requests. You can access the ICR from the Availity home page:

  • The ICR allows detailed text, photo images and attachments to be submitted along with your request.
  • Providers can also use this tool to make inquiries on previously submitted PA requests, regardless of how they were sent (phone, fax, ICR or another online tool).
  • To request or check the status of a PA request or decision, log in to Availity. Once logged in, select Patient Management | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

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Prior authorization contact information for Anthem

Providers and staff can also contact Anthem for help with prior authorization via the following methods:

Provider Services:


Hours: Monday to Friday from 8 a.m. to 6 p.m. ET (Interactive Voice Response (IVR) System available 24 hours a day, 7 days a week

 
 

Phone:

1-855-661-2028

 

Fax:

1-800-964-3627

Pharmacy department


Hours: Monday to Friday from 8 a.m. to 6 p.m. ET
 

Phone:

1-855-661-2028

Retail pharmacy fax:

1-844-879-2961

Medical injectables fax:

1-844-487-9289

The Medicaid-Approved Preferred Drug List (PDL) includes information such as mandatory generic requirements, PA, quantity limits, age limits or step therapy.

Pharmacy services billed with the following revenue codes always require prior authorization:

  • 0632 — Pharmacy multiple sources

Behavioral health

Behavioral health services billed with the following revenue codes always require prior authorization:

  • 0240 to 0249 — All-inclusive ancillary psychiatric
  • 0901, 0905 to 0907, 0913, 0917 — Behavioral health treatment services
  • 0944 to 0945 — Other therapeutic services
  • 0961 — Psychiatric professional fees

Long-term services and supports (LTSS)

Services billed with the following revenue codes ALWAYS require prior authorization:

  • 0023 — Home health prospective payment system
  • 0570 to 0572, 0579 — Home health aide
  • 0944 to 0945 — Other therapeutic services
  • 3101 to 3109 — Adult day and foster care

Related resources

Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid.

Provider tools & resources

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