Prior authorization denials UM1/198

Services that require prior authorization are limited to the units authorized during the authorization period. Units may only be used during the dates listed on the authorization. Services billed beyond the authorized units within the authorization period will deny with the code UM1/198 – Units Exceed Authorization. 

As an example, consider a patient that has the following authorizations:

• 100 units for January 1 to April 30
• 100 units from May 1 to July 30

If all 100 units for the first authorization are used between January 1 and April 15, claims for units billed between April 15 and April 30 will deny for units exceeding the authorization. The units in the second authorization cannot be used before the authorization period begins. Providers are encouraged to track unit usage to avoid this denial.

HealthKeepers, Inc. recommends submitting prior authorization requests for Anthem HealthKeepers Plus members via Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity. ICR offers a fast, efficient way to securely submit prior authorization requests with clinical documentation. You can also check status of an existing request and auto-authorize more than 40 common procedures.

What if I need assistance?

If you have questions about this communication, contact your local provider relationship management representative or call Provider Services at 800-901-0020.