Precertification Requirements
Anthem Blue Cross and Blue Shield (Anthem) recommends submitting precertification requests via Authorization Request, a secure utilization management tool available in Availity Essentials. Authorization Request offers a fast, efficient way to securely submit your requests with clinical documentation. You can also check the status of an existing request using the Authorization/Referral Dashboard or Authorization/Referral Inquiry.
Services requiring precertification
Providers are responsible for verifying precertification requirements before services are rendered. You can use the Precertification Lookup Tool or reference the provider manual to determine if authorization is needed.
Request precertification
We encourage providers to use Authorization Request in Availity Essentials for all notifications or precertification requests, including reporting a member’s pregnancy.
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Precertification contacts
Pharmacy
Prescription drugs, including specialty medications, some over-the-counter (OTC) medications and home infusion therapy solutions, are covered by ForwardHealth.
ForwardHealth Provider Services
Phone:
800-947-9627
TTY: 711
Website:
Medical
Contact Anthem Medical Management for medical precertification questions, including medical injectables not covered by ForwardHealth.
Anthem Medical Management
Phone:
855-558-1443
TTY: 711