Prior authorization lookup tool

Please verify benefit coverage prior to rendering services. Inpatient services and non-participating Anthem HealthKeepers Plus providers always require prior authorization.

Please note:

  1. This tool is for outpatient services only.
  2. It does not reflect benefits coverage, nor does it include an exhaustive listing of all non-covered services (in other words, experimental procedures, cosmetic surgery, etc.).
  3. Refer to the Provider Manual for coverages or limitations.

Please note that services listed as requiring precertification may not be covered benefits for a member.

To help facilitate a seamless transition in understanding Cardinal Care program changes as it relates to authorization requirements, the below guidance is being provided. If you are unsure or have any questions, please be sure to check member eligibility and benefit coverage before proceeding with any authorization requests or services by contacting Provider Services at 800-901-0020.

  • Choose ‘Cardinal Care CCC Plus Waiver’ if your member was previously considered CCC Plus, is currently enrolled and/or recently approved for the CCC Plus Waiver
  • Choose ‘Cardinal Care Medicaid/SCHIP/Family Care’ if your member was previously considered a Medallion 4.0 enrollee

To verify member eligibility or benefits:

  1. Log in to the Availity Essentials , or
  2. Use the Prior Authorization tool within Availity, or
  3. Contact Provider Services

To submit a prior authorization request:

  1. Log in to Availity
  2. Select Patient Registration from the top navigation.
  3. Select Auth/Referral Inquiry or Authorizations.

Provider tools & resources

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