Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJanuary 11, 2024

Prior authorization requirement changes effective March 1, 2024

Effective March 1, 2024, the CPT® codes below will require prior authorization (PA). All covered services are contingent upon medical necessity and benefit coverage at the time of service.

CUMG number

CUMG title

CPT code

MCG A-0356

MCG MCR L33785R010

High Frequency Chest Compression Device

A7025

MCG MCR N2801v3

Durable Medical Equipment: Ultraviolet Light Therapy System Panel

E0692

MCG MCR N2801v3

Durable Medical Equipment: Ultraviolet Light Therapy System Panel

E0693

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

  • Web: Once logged in to Availity at Availity.com.
  • Fax:
    • Inpatient (new emergent): 866-406-2803
    • Inpatient (concurrent emergent/new urgent): 844-765-5156
    • Outpatient: 844-765-5157
  • Phone:
    • Hoosier Healthwise — 866-408-6132
    • Healthy Indiana Plan — 844-533-1995
    • Hoosier Care Connect — 844-284-1798

The PA lookup tool allows providers to search codes by the specific line of business to determine if PA is required and which guideline is utilized for the case review. To access the PA lookup tool, go to providers.anthem.com/in, and select precertification lookup tool under the Claims drop-down. Contracted providers can also access the provider look up tool via Availity Essentials at Availity.com select the Payer Spaces then select the pre-cert look up tool tile.

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
  • Healthy Indiana Plan — 844-533-1995
  • Hoosier Care Connect — 844-284-1798

UM AROW A2023M0533

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-045404-23-CPN44255

PUBLICATIONS: February 2024 Provider Newsletter