Services requiring prior authorization: Certain physical therapy services

Effective February 1, 2020, HealthKeepers, Inc. requires prior authorization (PA) for certain physical therapy services for Anthem HealthKeepers Plus members.

 

We recommend that providers visit https://mediproviders.anthem.com/va/pages/pluto.aspx to review the list of services and service categories that currently require PA. Should providers need clarification regarding whether a specific code or service requires PA, they should call 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 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:

 

• Phone: 1-800-901-0020

 

• Fax: 1-800-964-3627

Regardless of PA requirement, all services must be medically necessary to be covered. To access our medical necessity criteria, visit https://www11.anthem.com/search.html.

 

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