Prior authorization requirement changes updated effective date November 1, 2022
Effective November 1, 2022, prior authorization (PA) requirements will change for multiple codes. The medical codes listed below will require PA by Anthem Blue Cross. Federal and state law, as well as state contract language, and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.
PA requirements will be added to the following:
- 81432: Hereditary breast cancer-related disorders (such as hereditary breast cancer, hereditary ovarian cancer, hereditary endometrial cancer); genomic sequence analysis panel, must include sequencing of at least 10 genes, always including BRCA1, BRCA2, CDH1, and MLH1
- L6026: Transcarpal/metacarpal or partial hand disarticulation prosthesis, external power, self-suspended, inner socket with removable forearm section, electrodes and cables, two batteries, charger, myoelectric control of terminal device, excludes terminal device
- L6715: Terminal device, multiple articulating digit, includes motor(s), initial issue, or replacement
To request a PA, you may use one of the following methods:
- Availity:* Once logged in to Availity at http://availity.com, select Patient Registration > Authorizations & Referrals, then select Authorizations or Auth/Referral Inquiry, as appropriate.
- Fax: 800-754-4708
- Medi-Cal Phone: 888-861-2246
- MCAP/MRMIP Phone: 877-273-4193
Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers on the provider website at https://providers.anthem.com/ca. Contracted and noncontracted providers who are unable to access Availity may call one of our Customer Care Centers at one the following numbers for assistance with PA requirements:
- Outside L.A. County: 800-407-4627
- Inside L.A. County: 888-285-7801
Email is the quickest and most direct way to receive important information Anthem Blue Cross. To start receiving email from us (including some sent in lieu of fax or mail), submit your information using our online form (https://bit.ly/3lLgko8).\
August 2022 Anthem Blue Cross Provider News - California