Provider specialty and subspecialty designations for utilization management

Anthem values the opportunity to collaborate with healthcare providers in ensuring adherence to industry standards, best practices, and both state and federal regulations.

Effective July 1, 2025, according to Senate Enrolled Act (SEA) 480, any prior authorization requests for health care services for covered individuals must be reviewed by a clinical peer as that is defined in the law.

To comply with this mandate, Anthem will require that all prior authorization submissions specify the National Provider Identifier (NPI) of the requesting provider. In cases where an advanced practice registered nurse (APRN) is involved, the NPI of the collaborating physician must also be included. This information will ensure Anthem can review the request with the appropriate clinical peer.

For prior authorization (PA) submission:

• Via fax: Provider’s NPI should be entered in the notes of the PA request.
• Via Availity Essentials: Provider’s NPI should be entered in the note section of Availity Essentials.

We are grateful for your care of our members and look forward to continued collaboration.