Anthem Blue Cross Blue Shield suspends additional authorization requirements to aid GA COVID-19 response
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Please note that the following information applies to Anthem’s Commercial health plans. Medicare plans are included when not otherwise required under State and/or Federal mandates. Please review the Medicare specific site noted above for details about these plans.
Anthem Blue Cross Blue Shield Suspends Additional Authorization Requirements to Aid GA COVID-19 Response
As the COVID-19 pandemic continues to spread throughout our communities, we appreciate that providers on the front line are committed to providing care to our members. Anthem is closely monitoring COVID-19 developments and what it means for our customers and our healthcare provider partners.
In addition to the proactive steps Anthem has already taken to support care providers and protect our members, associates and communities against COVID-19, Anthem in Georgia is taking additional measures outlined by Georgia Department of Insurance in Directive 20-EX-7. Effective March 26, Anthem has implemented the following for Anthem’s commercial Individual, employer-based fully-insured, self-insured (ASO), and Medicare plans for 60 days effective March 26 and then re-evaluate if an extension is warranted. Anthem encourages self-funded employer participation; however, self-insured employers will be able to opt out of participation in the measures described.
Suspension of Preauthorization Requirements for Scheduled Surgeries or Admissions at Hospitals:
Anthem is committed to working with and supporting hospitals. As of March 26, Anthem is suspending prior authorization requirements for scheduled surgeries or admissions at hospitals for the next 60 days to allow hospitals to utilize needed staff in clinical roles. We will not apply this measure to elective procedures as the state has already encouraged providers to reschedule elective procedures to conserve lifesaving supplies essential to combating the pandemic. Hospitals should use best efforts to continue admission notification to Anthem within 48-hours to verify eligibility and benefits for all members prior to rendering services and to assist with ensuring timely payments. Anthem may review any applicable cases retrospectively upon the resumption of retrospective review.
Suspension of Concurrent Review for Inpatient Hospital Services:
Anthem is suspending concurrent review requirements for 60 days effective March 26 to allow hospitals to utilize needed staff in clinical roles. However, hospitals should use best efforts to continue to submit concurrent reviews when able to assist with ensuring timely payments. Anthem may review any applicable cases retrospectively upon the resumption of retrospective review.
Waive requirements for location-based credentialing:
Anthem is waiving location-based credentialing for 60 days effective March 26 to allow providers to practice in locations they at which do not usually practice.
These changes are in addition to other changes to prior authorization and policy adjustments that Anthem is implementing to assist providers which can be accessed through the following link: https://providernews.anthem.com/georgia/article/important-covid-19-update-prior-authorization-and-other-policy-adjustments.