Prior authorization requirement changes

Effective August 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Anthem for Medicaid members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these PA rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

To request PA, you may use one of the following methods:

• Web: Once logged in to Availity Essentials at Availity.com.
• Fax: 800-964-3627
• Phone: 855-558-1443

Not all PA requirements are listed here. Detailed PA requirements are available to care providers on providers.anthem.com/wi on the Resources tab or for contracted care providers by accessing Availity.com. Care providers may also call Provider Services at 855-558-1443 for assistance with PA requirements.