Provider resources overview

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Prior Authorization
Claims & Disputes
Forms
Training Academy

We are committed to supporting you in providing quality care and services to the members in our network. Here, you will find frequently used forms, PDFs, provider manuals and guides, prior authorization information, practice policies, and support for delivering benefits to our members.

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Provider forms

Provider forms are located in our online library for easy access.

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Provider manuals and guides

Anthem provider manuals and guides provide key administrative information, including the quality improvement program, the utilization management program, quality standards for participation, claims appeals, reimbursement, and administration policies.

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Training Academy

Anthem Blue Cross and Blue Shield (Anthem) offers training and tutorials to support providers in continuing their education. Presentations, videos, and other training documentation will be added as they become available.

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Prior authorization requirements

To check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity Essentials or use our prior authorization lookup tool for outpatient services. Providers should use Availity Essentials to submit prior authorization requests for all medical (non-pharmacy) services.

Learn about Availity Essentials

Many of the tools you need — such as eligibility and benefits inquiry, and claims status inquiry – can now be accessed by logging into your account on the Availity Essentials Portal .

Electronic visit verification (EVV)

Electronic visit verification (EVV) is used by caregivers for some home and community-based services to document the time services begin and end. The Ohio Department of Medicaid provides an EVV system at no cost to all providers.

For more information on electronic visit verification (EVV) please visit the Ohio Department of Medicaid (ODM) EVV Homepage .

Related resources

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

Provider tools & resources

Join our network

We’re glad you’re interested in joining the Anthem network. We have a diverse network of exceptional healthcare professionals who ensure our members have uninterrupted access to the support they need.