Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 27, 2024

Prior authorization update

Effective April 1, 2024, the below CPT® codes will require prior authorization (PA). 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 to determine if PA is required and which guideline is used 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.

Detailed PA requirements are available to contracted providers via the provider self-service tool on Availity Essentials at Availity.com or go to providers.anthem.com/indiana-provider/home and select Log in to Availity Essentials.

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

LCD MolDX: Molecular Diagnostic Tests (MDT) (L36807): LCD MolDX: Molecular Diagnostic Tests (MDT) (L36807)

Molecular Diagnostic Tests

0287U

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-047117-23

PUBLICATIONS: April 2024 Provider Newsletter