Clinical Utilization Management Guidelines update

The Clinical Utilization Management (UM) Guidelines updates below were approved and adopted for Anthem Blue Cross and Blue Shield pre-service UM reviews for Healthy Indiana Plan (HIP), Hoosier Healthwise, and Hoosier Care Connect effective on or after April 1, 2023. All covered services are contingent upon medical necessity and benefit coverage at the time of service.

The prior authorization (PA) lookup tool allows providers to search codes by the specific program (HIP, Hoosier Healthwise, or Hoosier Care Connect) to determine if PA is required and which guideline is used for the case review. To access the PA lookup tool, go to https://providers.anthem.com/in, and select precertification lookup tool under the Claims drop-down.

Detailed PA requirements are available to contracted providers via the provider self-service tool on Availity Essentials at Availity.com or go to https://providers.anthem.com/in and select Launch Availity.

For assistance with questions regarding the PA requirement change, call Provider Services at one of the phone numbers listed below:

• Hoosier Healthwise: 866-408-6132
• HIP: 844-533-1995
• Hoosier Care Connect: 844-284-1798