Policy UpdatesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingDecember 15, 2023

Omidubicel prior authorization update

Effective February 1, 2024, Omidubicel will require prior authorization (PA). Medical Policy MED.00147 will be applied for PAs related to Omidubicel. All covered services are contingent upon medical necessity and benefit coverage at the time of service.

The precertification lookup tool allows providers to search codes by the specific line of business (such as Hoosier Healthwise, Healthy Indiana Plan [HIP], or Hoosier Care Connect) to determine if PA is required and which guideline is utilized for the case review. To access the precertification lookup tool, go to the provider website 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 or go to the provider website and select Log in to Availity.

For assistance with questions regarding the PA requirement change, please 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

Clinical Utilization Management Guidelines (CUMG) number

CUMG title

CPT® code

Med.00147

Cellular Therapy Products for Allogeneic Stem Cell Transplantation

Specific drug code TBD.

For all unclassified codes (for example, J3490), a PA is required.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-040844-23

PUBLICATIONS: January 2024 Provider Newsletter