Prior Authorization Requirements

Anthem Blue Cross (Anthem) is available by fax or Interactive Care Reviewer (ICR) 24/7 to accept prior authorization requests.

Our Interactive Care Reviewer (ICR) tool via Availity is the preferred method for submitting prior authorization requests, offering a streamlined and efficient experience for providers requesting inpatient and outpatient medical or behavioral health services for our members. Additionally, providers can use this tool to make inquiries on previously submitted requests, regardless of how they were sent (phone, fax, ICR or another online tool).

To request or check the status of a prior authorization request or decision for a particular plan member, access our Interactive Care Reviewer (ICR) tool via Availity. Once logged in, select Patient Registration | Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry as appropriate.

Don’t have an Availity account?

Need help with Availity?

Prior Authorization Contact Information

Providers and staff can also contact Anthem for help with prior authorization via the following methods:

Utilization Management (UM) for Medi-Cal Managed Care (Medi-Cal)

• Phone:1-888-831-2246
• Hours: Monday to Friday, 8 a.m. to 5 p.m.
• Fax:1-800-754-4708
• Behavioral Health: For prior authorization requests specific to behavioral health, please fax requests to 1-855-473-7902 or email Medi-calBHUM@wellpoint.com.

Utilization Management (UM) for Major Risk Medical Insurance Program (MRMIP)

Anthem Blue Cross Cal MediConnect Plan

• Customer Care Phone:1-855-817-5786
• Hours: Monday to Friday, 8 a.m. to 6 p.m.
• Medical Notification/Prior Authorization Fax:1-888-235-8468

Pharmacy

Pharmacy Prior Authorization Center for Medi-Cal:

• Hours: 24 hours a day, seven days a week
• Phone:800-977-2273 (TTY 711)

*For Medicare-Medicaid Plan pharmacy requests, please contact Anthem Blue Cross Cal MediConnect Plan (Medicare-Medicaid Plan) Customer Care at 855-817-5786.

Services requiring prior authorization

Anthem’s Prior Authorization Lookup Tool Online can assist with determining a code’s prior authorization requirements.

You can also refer to the provider manual for information about services that require prior authorization.

• Medi-Cal Managed Care and Major Risk Medical Insurance Program Provider Manual
• Cal MediConnect MMP Provider Manual

Emergency medical services

Anthem does not require prior authorization for treatment of emergency medical conditions. In the event of an emergency, members may access emergency services 24/7. In the event that the emergency room visit results in the member’s admission to the hospital, providers must contact Anthem within one business day following admission or post-stabilization.

Anthem is available via the Interactive Care Reviewer (ICR) in Availity 24/7 to accept emergent admission notification.