Notice of Changes to Prior Authorization Requirements: Updated Indiana Provider Manual posted to anthem.com

Indiana Provider Manual Update – Pre-certification/Pre-authorization Requests Effective Immediately

 

The Indiana Provider Manual has been updated to ensure Pre-certification/Pre-authorization Requests are submitted complete.

 

Updates to the Provider Manual:

 

• In the Utilization Management Section, under UM Definitions, definition #3 has been updated to add the essential elements needed when submitting a complete Pre-certification/Pre-authorization Request:
  
  
  • Place of Service (ex. Inpatient, Outpatient)
  • Type of Service (ex. Medical, Surgical, Behavioral Health)
  • Date of Service
  • Member Identification Number (with 3 character prefix if there is one)
  • Member Name and Member’s Date of Birth
  • Level of Service (ex. Elective, Urgent, Emergent)
  • Diagnosis
  • HCPCS or CPT Codes for scheduled Procedure
  • Name and address of Provider and NPI
  • Name and address of Facility and NPI
  • Clinical information to support the request

 

• The Interactive Care Reviewer (ICR) subsection under the Anthem Provider Website Section was moved to the Utilization Management Section.  

 

The updated Indiana Provider Manual is available online.

 

To access the Provider Manual, visit our provider website anthem.com/provider > select Indiana > scroll down to See Policies and Guidelines > scroll down and click on Download the Provider Manual > on the Publication webpage, select Indiana Provider Manual, or click here.

 

If you have questions, please contact your local Network Relations Consultant at 1-800-455-6805.