What. Choose your state below so that we can provide you with the most relevant information. Providers are responsible for verifying eligibility and benefits before providing services to Anthem Blue Cross (Anthem) members. Inpatient admissions, services and procedures received on an outpatient basis, such as in a doctor's office, For a service requiring a pre-service review, there isn’t a penalty, but Premera will hold the claim and ask for medical records. If you are providing service to out-of-area Blue Cross and Blue Shield (BCBS) members, please note: Some BCBS Plans have radiology management programs, other than AIM.

Our resources vary by state. For a list of these drugs, please click here or contact the Customer Service number on your member ID card. We look forward to working with you to provide quality service for our members.Sydney Care is offered through an arrangement with CareMarket, Inc. Sydney Health and Sydney Care are service marks of CareMarket Inc., © 2020.© 2005 - 2020 copyright of Anthem Insurance Companies, Inc. Prior Authorization Lists for Blue Cross Medicare Advantage (PPO) SM and Blue Cross Medicare Advantage (HMO) SM; Prior Authorization Lists for Designated Groups. Not getting prior authorization beforehand can result in a payment penalty for you or the member. Please update your browser if the service fails to run our website. We’ve provided the following resources to help you understand Anthem’s prior authorization process and obtain authorization for your patients when it’s required.Your browser is not supported.
Oncology drugs and medical injectables. Prior authorization, sometimes called PA or pre-certification, is the how Blue Cross makes sure the treatment your doctor prescribes is medically necessary. Serving Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin.The resources for our providers may differ between states. Your dashboard may experience future loading problems if not resolved. Prior Authorization & Claims Request Prior Authorization. Prior Authorization Health insurance can be complicated—especially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Except for an emergency, failure to obtain prior authorization (PA) for the services listed below will result in a denial for reimbursement.The links below contain information outlining the services that require PA for Anthem members enrolled in Medi-Cal Managed Care, Medi-Cal Access Program, L.A. Care, and Major Risk Medical Insurance Program (MRMIP). Prior Authorization is required before these drugs are administered in these locations: a doctor's office, at home, outpatient hospital, ambulatory surgical center or a health clinic. You can also visit The resources on this page are specific to your state. Except for an emergency, failure to obtain prior authorization (PA) for the services listed below will result in a denial for reimbursement. We were unable to automatically detect your location, but you can choose your state manually to see content that is most relevant to you.It looks like you're outside the United States. Choose your location to get started.Health insurance can be complicated—especially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification). Providers are responsible for verifying eligibility and benefits before providing services to Anthem Blue Cross (Anthem) members. We use established clinical guidelines to confirm medical necessity when your health plan contract requires prior authorization. Prior review (prior plan approval, prior authorization, prospective review or certification) is the process BCBSNC uses to review the provision of certain medical services and medications against health care management guidelines prior to the services being provided.

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