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.
Don’t have an Availity account?
Prior authorization contact information for Anthem
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
Retail pharmacy fax:
Medical injectables fax:
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 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