Our utilization management (UM) decisions are based on written criteria, 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 select “Medical Policies, Clinical UM Guidelines, and Pre-Cert Requirements” from the Provider home page at anthem.com.

 

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 am - 5:00 pm, Monday through Friday (except on holidays). More hours may be available in your area.  Federal Employee Program hours are 8:00 am - 7:00 pm ET.
  • 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 phone numbers below are for physicians and their staffs. Members should call the member service number on their health plan ID card.

 

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.


 



To discuss UM Process

and Authorizations

To Discuss

Peer-to-Peer

UM Denials w/Physicians



To Request

UM Criteria

IN

1-800-345-4348,

1-877-814-4803

Behavioral Health:
   1-866-582-2293

Transplant: 1-800-824-0581

Autism: 1-844-269-0538

1-888 870 9342

1-877-814-4803

KY

1-800-568-0075

KEHP: 1-844-402-5347

Behavioral Health:
   1-866-582-2293

Transplant: 1-800-824-0581

Autism: 1-844-269-0538

1-877-814-4803

1-877-814-4803

MO

1-800-992-5498,

1-866-398-1922

Behavioral Health:
    1-866-302-1015

Transplant: 1-800-824-0581

Autism: 1-844-269-0538

1-800-992-5498,

1-866-398-1922

CDHP/Lumenos:

   1-866-398-1922

1-800-992-5498,

1-866-398-1922

OH

1-800-752-1182

Behavioral Health:
   1-866-582-2293

Transplant: 1-800-824-0581

Autism: 844-269-0538

1-877-814-4803

1-877-814-4803

WI

1-800-242-1527,
1-800-472-6909,

1-800-472-8909,
1-866-643-7087

Transplant: 1-800-824-0581

Autism: 1-844-269-0538

1-800-242-1527,

1-800-472-6909,

1-866-643-7087

1-800-242-1527,

1-800-472-6909

FEP/ Nat'l

FEP: 1-800-860-2156

Fax: 1-800 732-8318 (UM)

Fax: 1-877 606-3807 (ABD)

FEP: 1-800-860-2156

Nat'l: 1-800-821-1453

 

FEP: 1-800-860-2156

Fax: 1-800 732-8318 (UM)

Fax: 1-877 606-3807 (ABD)



TTY Information

 

 

TTY

Voice

IN

711 or

1-800-743-3333 (V/T)

1-800-743-3333 (V/T)

KY

711 or

1-800-648-6056 (T/ASCII)

1-800-648-6057 (V)

MO

711 or

1-800-735-2966 (TTY/ASCII)

1-866-735-2460 (V)

OH

711 or

1-800-750-0750 (V/T)

1-800-750-0750 (V/T)

WI

711 or

1-800-947-3529 (T)

1-800-947-6644 (V)


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.



Featured In:
December 2018 Anthem Indiana Provider Newsletter