Important update: Claims denying for authorization incorrectly when authorization is not required resolution plan
Unfortunately, the December 2022 correction was not broad enough to capture the full scope of the error. For example, office visits requiring a copayment by a member continued to be impacted. An expanded error correction went into place on February 23, 2023.
We are now working on reprocessing claims that were denied incorrectly between November 1, 2022, and February 23, 2023. Anthem Blue Cross and Blue Shield (Anthem) is treating this reprocessing effort as a high priority. Anthem will begin creating impact reports and reprocessing of the incorrectly denied claims the week of February 27, 2023. Our reprocessing will include adding on any penalties and interest, as applicable, that may be due to providers under Colorado law or our contracts. We anticipate that the majority of the claim reprocessing should be completed by the end of March 2023. Providers do not need to take any further action on these claims. However, we understand if you want to reach out for any updates we can provide in the meantime.
If you received what you believe to be an incorrect denial for an authorization on a claim with a process date after February 23, 2023, please let us know.
If you are receiving authorization denials for MRI/CT with denial code 197, these are most likely appropriate denials and authorization should go through Carelon Medical Benefits Management, Inc.* (previously known as AIM Specialty Health).
Please use one of the following options to see if a prior authorization is required:
- Authorization list:
- Go to Anthem.com, select Providers. Under the Claims heading, select Prior Authorizations
- Precertification Lookup tool:
- Availity.com* > Payer Spaces > Anthem tile > Applications > Precertification Lookup Tool
- Chat: Use the Chat tool to ask a question about prior authorization, appeals status, claims, benefits, eligibility, and more:
- Access via Availity.com > Payer Spaces > Anthem tile > Applications > Chat
- Phone: reference the number on the back of the member’s ID card
If an authorization is required, the preferred method of submitting a prior authorization is online via the Availity Authorization tool through Availity.com > Patient Registration > Authorization and Referrals > Authorizations.
We thank you for your patience as we resolve this matter.
Claims denying for authorization incorrectly when authorization is not required resolution plan