To help ensure clinical consistency and quality practices across all markets, Anthem Blue Cross and Blue Shield (Anthem) will change how we handle prior authorization requests for inpatient hospital admissions that do not meet Anthem’s clinical guidelines and criteria. Beginning October 1, 2020, we will no longer apply a 30 percent penalty to these requests. Instead, these prior authorization requests that do not meet our clinical guidelines and criteria will be denied. All applicable appeal options remain available.


Please note, this change does not affect the penalty for late prior authorization requests. If applicable, Anthem will apply the standard penalty percentage for late prior authorization requests.


If you have questions, please contact Provider Services.

* Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.



Featured In:
July 2020 Anthem Provider News - Ohio