Our utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as the member’s coverage according to their health plan. We do not reward providers or other individuals for issuing denials of coverage, service or care. Nor, do we make decisions about hiring, promoting, or terminating these individuals based on the idea or thought that they will deny benefits. In addition, we do not offer financial incentives for UM decision makers to encourage decisions resulting in under-utilization. Anthem’s medical policies are available on Anthem’s website at anthem.com.

 

You can also request a free copy of our UM criteria from our medical management department, and providers may discuss a UM denial decision with a physician reviewer by calling us at the toll-free numbers listed below. UM criteria are also available on the web. Just go to Anthem.com, then scroll down and select Tools for Providers>Find Information That’s Tailored for You>Select State>Review Policies>View Medical Policies and Clinical UM Guidelines.

 

We work with providers to answer questions about the utilization management process and the authorization of care. Here’s how the process works:

  • Call us toll free from 8:30 a.m.–5 p.m. Monday through Friday (except on holidays). More hours may be available in your area.  Federal Employee Program hours are 8:00 a.m.–7 p.m. Eastern.
  • If you call after normal business hours, you can leave a private message with your contact information. Our staff will return your call on the next business day. Calls received after midnight will be returned the same business day. 
  • Our associates will contact you about your UM inquiries during business hours, unless otherwise agreed upon.

 

The following phone lines are for physicians and their staffs. Members should call the customer service number on their health plan ID card.

To discuss UM Process & Auth

To Discuss Peer-to-Peer

UM Denials w/Phys

To Request

UM Criteria


TTY/TDD

 

BUSINESS HOURS

800 662-9023,

800 722-6614,

855-343-4851 or
855-343-4852

 

Transplant

800-824-0581

 

Behavioral Health:

800-292-2879

 

Autism:

844 269 0538

 

University System of Georgia (USG):

800-233-5765

Behavioral Health:

844 269-0535

 

State Health Benefit (SHBP): 

Behavioral Health:

855 679-5725

 

FEP

Phone 800-860-2156

FAX 800 732-8318 (UM)

FAX 877 606-3807 (ABD)

877-771-9165

 

Behavioral Health:

800-292-2879

 

Adaptive Behavioral Treatment:

844-269-0538

 

University System of Georgia (USG):

877-771-9165

 

Behavioral Health:    
844 269-0535

 

State Health Benefit

(SHBP):

Behavioral Health:

855 679-5725

 

State Health Benefit (SHBP) Medical:

855 668 6442

 

FEP:

Phone 800-860-2156

800 662-9023,

800 722-6614,

855-343-4851 or
855-343-4852

 

Behavioral Health:

800-292-2879

 

University System of Georgia (USG):

800-233-5765

 

Behavioral Health: 844 269-0535

 

State Health Benefit (SHBP)  Behavioral Health:  855 679-5725

 

State Health Benefit (SHBP):  Medical:

855 668 6442

 

FEP:

Phone 800-860-2156

FAX 800 732-8318 (UM)

FAX 877 606-3807 (ABD)

711

Or

TTY: 800-255-0056 (T)

Voice: 800-255-0135 (V)

 

Call us toll free from 8:30 a.m.–5:00 p.m. Monday through Friday (except on holidays).  More hours may be available in your area.  Federal Employee Program hours are 8:00 a.m.–7:00 p.m. Eastern.

 

 

For language assistance, members can simply call the Customer Service phone number on the back of their ID card and a representative will be able to assist them.

Our utilization management associates identify themselves to all callers by first name, title and our company name when making or returning calls. They can inform you about specific utilization management requirements, operational review procedures, and discuss utilization management decisions with you.



827-1220-PN-GA



Featured In:
December 2020 Anthem Provider News - Georgia