Important information about utilization management

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 underutilization. Our medical policies are available on our provider website at anthem.com/provider/policies/clinical-guidelines/search/.

 

You can request a free copy of our UM criteria from our Medical Management department. Providers can discuss a UM denial decision with a physician reviewer by calling us toll-free at the numbers listed below. You can access UM criteria online at the web address listed above.

 

We are staffed with clinical professionals who coordinate our members’ care and are available 24/7 to accept prior authorization requests. Secured voicemail is available during off-business hours. A clinical professional will return your call within the next business day. Our staff will identify themselves by name, title, and organization name when initiating or returning calls regarding UM issues.

 

You can submit prior authorization requests by:

• Calling us at:
  • Hoosier Healthwise: 866‑408‑6132
  • Healthy Indiana Plan: 844‑533‑1995
  • Hoosier Care Connect: 844‑284‑1798
• Faxing us at:
  • Inpatient medical fax: 866-406-2803
  • Outpatient medical fax: 866-406-2803
  • Pharmacy fax (retail): 844-864-7860
    • Medical injectable: 888-209-7838
  • Behavioral health inpatient fax: 844-452-8074
  • Behavioral health outpatient fax: 844-456-2698
• Submitting online at:
  • Availity*: availity.com

 

Have questions about utilization decisions or the UM process?

Call our Provider Helpline at the numbers below Monday through Friday from 8 a.m. to 8 p.m.:

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

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

 

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