Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingAugust 23, 2023

Prior Authorization Requirement Changes Effective November 1, 2023

Prior authorization update

Effective November 1, 2023 the below CPT® codes will require prior authorization. All covered services are contingent upon medical necessity and benefit coverage at the time of service.

The PA lookup tool allows providers to search codes by the specific line of business (Medicaid/SCHIP/Family Care, or Hoosier Care Connect) 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

CUMG number

CUMG title

CPT® code

Head and Neck Surgery GRG

Nasopharyngoscopy, surgical, with dilation of eustachian tube (in other words, balloon dilation); unilateral

69705

Head and Neck Surgery GRG

Nasopharyngoscopy, surgical, with dilation of eustachian tube (in other words, balloon dilation); bilateral

69706

* Availity, LLC is an independent company providing administrative support services on behalf of the health plan.
UM AROW #4500

INBCBS-CD-028261-23-CPN27261

PUBLICATIONS: September 2023 Provider Newsletter