Virginia Commercial with Anthem Blue Cross and Blue Shield: local precertification change notification

The following service will be added to the precertification list for the effective date listed below.

Precertification responsibility: The ordering or rendering provider of service is responsible for completing the precertification process.

HMO plans: Services that require precertification will be denied if rendered without the appropriate precertification for in-network providers. HMO members may not have benefits for non-emergency services rendered by out of network providers and are subject to review which could result in a denial.

PPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement.

EPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement. No out-of-network benefit is available with the exception of ER/Urgent Care and authorized services.

Requesting precertification for Anthem Blue Cross and Blue Shield members in Virginia

To obtain precertification, providers can access Availity Essentials* at Availity.com. To submit the authorization, select Authorizations from the home page. Calling the Utilization Management department using the number on the back of the member’s identification card can cause delays and digital submissions are recommended. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed.