September 1, 2022
Prior authorization requirement changes effective date December 1, 2022
This communication applies to the Medicare Advantage and Medicare-Medicaid Plan (MMP) programs for Anthem Blue Cross (Anthem).
On December 1, 2022, Anthem prior authorization (PA) requirements will change for the following code. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.
Prior authorization requirements will be added for the following code:
L6715 — Terminal device, multiple articulating digit, includes motor(s), initial issue, or replacement
Not all PA requirements are listed here. Detailed PA requirements are available to providers on the provider website at https://mediproviders.anthem.com/ca/pages/communications-updates.aspx or by accessing Availity* at https://availity.com.
Providers may also call Provider Services for assistance with PA requirements at 855-817-5786 for Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) or the number on the back of the patient’s member ID card for Medicare Advantage.
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