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 (Anthem) is available via phone or the Interactive Care Reviewer (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

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

Anthem Provider Services

  • Phone: 1-800-450-8753
  • Hours: Monday to Friday 8:30 a.m. to 5:30 p.m.
  • Fax: 1-800-964-3627

Anthem Pharmacy Department

  • Hours: Monday to Friday 8 a.m. to 7 p.m.; Saturday 10 a.m. to 2 p.m.
  • Retail Pharmacy Fax: 1-844-490-4877
  • Medical Injectables Fax: 1-844-493-9206

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:

  • 0240–0249 — All-inclusive ancillary psychiatric
  • 0901, 0905–0907, 0913, 0917 — Behavioral health treatment services
  • 0944–0945 — 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
  • 0570–0572, 0579 — Home health aide
  • 0944–0945 — Other therapeutic services
  • 3101–3109 — Adult day and foster care

Related resources

Provider tools & resources

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