Anthem Blue Cross announces changes in medical non-oncology specialty drug reviews effective June 15, 2019

We continue to streamline our medical specialty drug reviews by transitioning the medical non-oncology drug review process from AIM to Anthem Blue Cross’ medical specialty drug review team.

What is changing?

• Beginning on June 15, 2019, for all requests, regardless of service date, providers will need to submit a new prior authorization request by contacting Anthem’s medical specialty drug review team:
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  • By phone at 1-833-293-0659
  • By fax at 1-888-223-0550 or
  • Online at Availity.com available 24/7

 

• All inquiries about an existing request initially submitted prior to June 15 to AIM or Anthem, peer-to-peer review, or reconsideration will be managed by Anthem’s medical specialty drug review team.

 

What is not changing?

• AIM will continue to be responsible for performing medical oncology drug reviews for existing commercial medical benefit for our employer group business.
• Medical policies and clinical guidelines for non-drug specialty topics will continue to reside at the Anthem Blue Cross Web site at http://www.anthem.com/ca and then hovering over “Providers”, then selecting “Policies and Guidelines” under the Provider Resources column, scrolling down to select “View Medical Policies & UM Guidelines”, then selecting “Medical Policies and Clinical UM Guidelines (for Local Plan members)”, then selecting “Continue” at the bottom of the page.   

• Post Service Clinical Coverage Reviews and Grievance and Appeals processes and teams will not change.

 

For your convenience here is a summary of the medical specialty drug process changes:

Prior to June 15, 2019	Submit a new prior authorization request for medical specialty drug reviews	Call Anthem Blue Cross at 1-833-293-0659 or fax us at 1-888-223-0550 for or Access online at www.availity.com available 24/7
Beginning June 15, 2019	Inquire about an existing request initially submitted to AIM or Anthem Blue Cross prior to June 15, peer-to-peer review, or reconsideration	Call Anthem Blue Cross at 1-833-293-0659