Precertification requirements reminder
HealthKeepers, Inc. reminds providers that Anthem HealthKeepers Plus authorization requirements are the responsibility of the provider and should be renewed and validated prior to service. Precertification requests should be made, at a minimum, three days before the scheduled/elective procedure/request. HealthKeepers, Inc. will also authorize services retroactively up to 10 calendar days after service. In the Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) rollout, we have been lenient with that requirement. Effective October 15, 2018, HealthKeepers, Inc. will actively enforce these timelines to ensure timely processing and adequate care for our members.
Failure to obtain precertification for a scheduled/elective procedure/request may result in an administrative review and a denial of services.
HealthKeepers, Inc. does not require precertification for treatment of emergency medical conditions and will cover emergency and post-stabilization services. HealthKeepers, Inc. will not retroactively deny a claim for an emergency screening examination because the condition was a nonemergency.
To determine whether precertification is needed, use the Precertification Lookup Tool at https://mediproviders.anthem.com/va > Precertification > Precertification Lookup Tool.
Use one of the following methods to request precertification:
- Web: Interactive Care Reviewer tool via https://www.availity.com
- Fax: 1-800-964-3627
- Phone: 1-800-901-0200
The Precertification Request Form is located at https://mediproviders.anthem.com/va > Precertification > How to Request Precertification > Forms & Other Resources. To get the fastest response on an authorization request:
- Complete the form online, then print and fax it. Doing so will ensure legibility.
- Fill out the form completely. Unanswered questions typically result in delays.
HealthKeepers, Inc. revises forms periodically. Outdated forms can delay a request.
If you have questions about this communication or need assistance with any other item, call Provider Services at 1-800-901-0020.
December 2018 Anthem Provider Newsletter - Virginia