Services requiring prior authorization

Category:  Medicaid


Effective February 1, 2020, HealthKeepers, Inc. will require prior authorization (PA) for certain durable medical equipment for Anthem HealthKeepers Plus members.

 

Codes requiring PA as of February 1, 2020:

 

E0983

E0986

E2300

E2311

E2312

E2313

E2331

E2609

E2617

We recommend providers visit https://mediproviders.anthem.com/va > Precertification to review the list of services and service categories that currently require PA. Should a provider need clarification regarding whether a specific code or service requires PA, they should use the Utilization Management contact numbers below.

 

The list of services requiring PA will be updated as needed.

 

Providers are responsible for verifying eligibility and benefits for Anthem HealthKeepers Plus members before providing services. Except for an emergency, failure to obtain PA for the services requiring PA may result in denial of reimbursement.

 

Requesting PA

 

To request PA, report a medical admission or ask questions regarding PA, contact the Utilization Management department at the following:

 

• Fax: 1-800-964-3627

 

• Phone: 1-855-661-2028

Regardless of PA requirement, all services must be medically necessary to be covered. To access our medical necessity criteria, visit https://www.anthem.com/home-providers.html > Select a State > choose Virginia > scroll down and select See Policies and Guidelines > choose View Coverage & UM Guidelines.

 

Questions

 

If you have any questions about this communication, please contact your Provider Relations representative or call Provider Services at 1‑800‑901‑0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687.