Reconsideration process for pre-service or concurrent inpatient stay

A reconsideration process is available to providers following an adverse determination. During the reconsideration process, providers will have an opportunity to submit additional clinical information to substantiate medical necessity for a previously denied pre-service or concurrent inpatient stay. To submit a reconsideration, submit new clinical information and place reconsideration on the cover sheet.

Inpatient authorization fax number:

• 877-643-0671 (Physical Health)
• 866-577-2184 (Behavioral Health)

Timeframes for reconsideration of denied services:

• Reconsideration: 30 calendar days after the date of utilization management denial
• Peer-to-peer: seven calendar days after the date of utilization management denial
• Appeals: within 60 calendar days from the date of utilization management denial

Note: A reconsideration is not an appeal and does not limit subsequent appeal rights.
For further information, refer to our provider website at providers.anthem.com/oh.

If you have any questions for Anthem, contact your dedicated Provider Relationship Account Management representative or email OhioMedicaidProvider@anthem.com.