New Prior Auth Pass Program available for providers who meet criteria

As part of our commitment to provider collaboration, Anthem is introducing a new program to reduce the administrative burden associated with current prior authorization (PA) processes for providers who are contracted with Anthem in Connecticut. The Prior Auth Pass Program allows providers who meet program requirements to waive prior authorization for select outpatient medical procedures that generally have high rates of PA requests and approvals.

 

For providers that meet all program criteria and agree to participate in the Prior Auth Pass Program, the provider will no longer need to submit a request for a PA decision for a predetermined list of common medical procedures. They will simply verify that the patient is an Anthem member* receiving services in Connecticut and then provide the eligible service.

 

Current criteria for participation in Anthem’s Prior Auth Pass Program are as follows:

• Participation in the Cooperative Care value-based program, which includes meaningful shared risk for their Commercial patient population.
• Demonstration of historically high prior authorization approval rates of 90% or greater for program procedure codes.
• Commitment to Anthem’s back-end monitoring process to manage under- and over-utilization.
• Having technical system capabilities in place to allow for timely adoption and implementation.

 

For questions about fulfilling the criteria and participating in the Prior Auth Pass Program, please contact CTNetworkManagement-SM@anthem.com.

 

*Exceptions: BlueCard Host members, Federal Employee Program members, New York State and New York City employees.