Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests. 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. Additionally, providers can use this tool to make inquiries on
previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool). To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate. Don’t have an Availity account?Prior Authorization Contact InformationProviders and staff can also contact Anthem for help with prior authorization via the following methods: Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal)
Utilization Management (UM) for Major Risk Medical Insurance Program (MRMIP)
Anthem Blue Cross Cal MediConnect Plan
PharmacyPharmacy Prior Authorization Center for Medi-Cal:
*For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786. Services requiring prior authorizationAnthem’s Prior Authorization Lookup Tool Online can assist with determining a code’s prior authorization requirements. You can also refer to the provider manual for information about services that require prior authorization.
Emergency medical servicesAnthem does not require prior authorization for treatment of emergency medical conditions. In the event of an emergency, members may access emergency services 24/7. In the event that the emergency room visit results in the member’s admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization. Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification. Related ResourcesProvider tools & resources
Interested in becoming a provider in the Anthem network?We look forward to working with you to provide quality services to our members. Some procedures, medical and surgical services, specific equipment, and select prescription drugs require prior authorization. A prior authorization is an approval review that Blue Shield of California Promise Health Plan conducts. To request prior authorization for treatment or for a drug, you, your doctor, other prescriber, or appointed representative need to contact Blue Shield of California Promise Health Plan and provide necessary clinical information. If this information is not submitted, or does not meet the prior authorization criteria, the Health Plan may not cover the service or drug. For a prior authorization request to be considered for approval, a doctor must provide clinical information which may include, but is not limited to, the following:
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You may also contact Blue Shield Promise Cal MediConnect Plan Customer Care at the number listed above and ask to obtain the total number of the plan's grievances, appeals, and exceptions. Part D Coverage DeterminationCoverage determinations are decisions that Blue Shield Promise Cal MediConnect Plan makes about your coverage of prescription drugs. You, your provider, or other prescriber can contact Customer Care at the number listed above
to request a coverage determination. Your provider may use the optional Drug Coverage Form to submit their requests. However, this form is not necessary to request a coverage determination. What is the fax number for Anthem Blue Cross of California?Phone: Call 1‑888‑831‑2246, option 3 and ask for a form to be faxed to you. Fax: Send your request to: 1-800-754-4708. Anthem Blue Cross is the trade name of Blue Cross of California.
What form do providers in California use to request prior authorization?Providers must request CCS services using a SAR form. Note: Providers should verify CCS eligibility before submitting a SAR. Providers are required to submit documentation to substantiate medical necessity at the time the SAR is submitted.
Why is it important for providers to submit claims with the correct prefix?Three-character prefix: The three-character prefix on the member's ID card is the key element used to identify the plan to which the member belongs and to correctly route claims. It is critical to confirm membership, eligibility and coverage.
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Blue shield of california prior authorization fax number
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