Prior authorization changes

Effective December 1, 2019, prior authorization (PA) requirements are changing for the codes listed below. The listed codes will require PA by Anthem Blue Cross and Blue Shield for Hoosier Healthwise, Healthy Indiana Plan (HIP) and Hoosier Care Connect members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

PA requirements are being added to the following:

• Lower extremity prosthesis – shank foot system with vertical loading pylon (L5987)
• Gait trainer, pediatric size – anterior support, includes all accessories and components (E8002)
• Wheelchair, pediatric size – tilt-in-space, folding, adjustable, without seating system (E1234)
• Wheelchair, pediatric size – tilt-in-space, rigid, adjustable, without seating system (E1233)
• Transport chair, pediatric size (E1037)
• Multi-positional patient transfer system with integrated seat, operated by care giver (E1035)
• Wheelchair accessory – ventilator tray, gimbaled (E1030)
• Water circulating heat pad with pump (E0217)

 

To request PA, you may use one of the following methods:

• Web: availity.com
• Fax:
  • o 1-866-406-2803 (inpatient – new emergent)
  • o 1-844-765-5156 (inpatient – concurrent emergent/new urgent)
  • o 1-844-765-5157 (outpatient)
• Phone:
  • o Hoosier Healthwise: 1-866-408-6132
  • o Healthy Indiana Plan: 1-844-533-1995
  • o Hoosier Care Connect: 1-844-284-1798

 

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers by accessing the Precertification Lookup Tool at availity.com via anthem.com/inmedicaiddoc. Contracted and non-contracted providers who are unable to access the Availity Portal can call Provider Services for:

• Hoosier Healthwise: 1‑866‑408‑6132
• Healthy Indiana Plan: 1‑844‑533‑1995
• Hoosier Care Connect: 1‑844‑284‑1798