Our utilization management (UM) decisions are based on the appropriateness of care and service needed, as well as the member’s coverage according to their health plan. We do not reward providers or other individuals for issuing denials of coverage, service or care. Nor do we make decisions about hiring, promoting, or terminating these individuals based on the idea or thought that they will deny benefits. In addition, we do not offer financial incentives for UM decision makers to encourage decisions resulting in under-utilization. Anthem Blue Cross and Blue Shield (Anthem)’s medical policies are available on Anthem’s website at anthem.com.

 

You can also request a free copy of our UM criteria from our medical management department, and providers may discuss a UM denial decision with a physician reviewer by calling us at the toll-free numbers listed below. 

 

UM criteria are also available on the web. Just go to anthem.com, then select the Providers tab at the top of the webpage > under Provider Resources select Policies, Guidelines & Manuals > select your state > scroll down and select View Medical Policies and Clinical UM Guidelines.

 

We work with providers to answer questions about the UM process and the authorization of care. Here’s how the process works:

  • Call us toll free from 8:30 a.m. to 5:00 p.m. Eastern time, Monday through Friday (except on holidays). More hours may be available in your area. Federal Employee Program hours are 8:00 a.m. to 7:00 p.m. Eastern time.
  • If you call after normal business hours, you can leave a private message with your contact information. Our staff will return your call on the next business day. Calls received after 12 midnight will be returned the same business day. 
  • Our associates will contact you about your UM inquiries during business hours, unless otherwise agreed upon.

 

Our UM associates identify themselves to all callers by first name, title and our company name when making or returning calls. They can inform you about specific UM requirements, operational review procedures, and discuss UM decisions with you.

 

For language assistance, members can simply call the Customer Service phone number on the back of their ID card and a representative will be able to assist them.

 

The following phone lines are for physicians and their staffs. Members should call the customer service number on their health plan ID card.

 

 

To discuss UM Process & Authorizations

To discuss Peer-to-Peer

UM Denials /Physicians

To request UM Criteria

Business Hours

Indiana

800-345-4348

877-814-4803

 

Transplant

800-824-0581

 

Behavioral Health

866-582-2293

 

Autism

844-269-0538

888 870 9342

 

Adaptive Behavioral Treatment

844-269-0538

 

National
800-821-1453;
866-776-4793

877-814-4803

 

Behavioral Health

866-582-2293

8:30 a.m. – 5:00 p.m. ET

Monday through Friday (except on holidays).  More hours may be available in your area. 

Kentucky

800-568-0075

 

KEHP

844-402-5347

 

Transplant

800-824-0581

 

Behavioral Health

866-582-2293

 

Autism

844-269-0538

877-814-4803

 

Adaptive Behavioral Treatment

844-269-0538

 

National:
800-821-1453;

866-776-4793;

888-870-9342

877-814-4803

 

Behavioral Health

866-582-2293

8:30 a.m. – 5:00 p.m. ET

Monday through Friday (except on holidays).  More hours may be available in your area. 

Missouri

800-992-5498

866-398-1922

 

Transplant

800-824-0581

 

Behavioral Health

866-302-1015

 

Autism

844-269-0538

800-992-5498

866-398-1922

 

CDHP/Lumenos

866-398-1922

 

Adaptive Behavioral Treatment

844-269-0538

 

National

800-821-1453;

866-776-4793

800-992-5498

866-398-1922

 

Behavioral Health

866-302-1015

8:30 a.m. – 5:00 p.m. ET

Monday through Friday (except on holidays).  More hours may be available in your area. 

Ohio

800-752-1182

 

Transplant

800-824-0581

 

Behavioral Health

866-582-2293

 

Autism

844-269-0538

877-814-4803

 

Adaptive Behavioral Treatment

844-269-0538

 

National:
800-821-1453;
866-776-4793

877-814-4803

 

Behavioral Health

866-582-2293

8:30 a.m. – 5:00 p.m. ET

Monday through Friday (except on holidays).  More hours may be available in your area. 

Wisconsin

800-242-1527 

800-472-6909

800-472-8909

866-643-7087

 

Transplant

800-824-0581

 

Behavioral Health

866-302-1015

 

Autism

844-269-0538

800-242-1527

800-472-6909

866-643-7087

 

Adaptive Behavioral Treatment

844-269-0538

 

National

800-821-1453

866-776-4793

800-242-1527

800-472-6909

 

Behavioral Health

866-302-1015

8:30 a.m. – 5:00 p.m. ET

Monday through Friday (except on holidays).  More hours may be available in your area. 

FEP

800-860-2156

Fax: 800 732-8318 (UM)

Fax: 877 606-3807 (ABD)

800-860-2156

800-860-2156

Fax: 800 732-8318 (UM)

Fax: 877 606-3807 (ABD)

8:00 a.m. – 7:00 p.m. ET.

 

 

TTY Information

 

 

 

TTY

Voice

Indiana

711 or

1-800-743-3333 (V/T)

1-800-743-3333 (V/T)

Kentucky

711 or

1-800-648-6056 (T/ASCII/HCO)

1-800-648-6057 (V)

Missouri

711 or

1-800-735-2966 (TTY/ASCII)

1-866-735-2460 (V)

Ohio

711 or

1-800-750-0750 (TTY/Voice/HCO)

1-800-750-0750 (TTY/Voice/HCO)

Wisconsin

711 or

1-800-947-3529 (TTY/HCO)

1-800-947-6644 (V)

 

827-1220-PN-CNT



Featured In:
December 2020 Anthem Provider News - Missouri