What is Anthem Authorization & How to Obtain Anthem Prior Authorizations?
A Comprehensive Guide About Anthem Prior Authorization
Prior authorization is like a live jacket for a drowning person. It plays a significant role in providing quality treatment in the healthcare sector. Healthcare providers are the real heroes for patients, but nobody can win the game individually. As a trusted partner to healthcare providers at House of Outsourcing, we put our sincere potential to navigate insurance requirements cost management and to ensure premium care of patients.
Prior authorization bypasses the healthcare providers under the approval process from insurance companies before delivering certain medical services. It controls the cost management, seamless care process, and quality assurance.
Why Anthem Prior Authorization Matters?
As a dominant healthcare insurer, Anthem prioritizes prior authorization. The following factors describe the importance of prior authorization in Anthem’s insurance context:
1. Customized Guidelines:
Anthem’s prior authorization requirements did not comply only with patient needs, but we ensure the customization according to evidence-based practices that favour both patients and providers. After getting in a loop with providers, specific services, treatments, and special medical procedures are allowed.
2. Balancing Access and Cost:
Anthem maintains a balance between quality and cost. We delicately handle the prior authorization process by delivering the best services under budget-friendly payment plans.
3. Collaboration with Providers:
We cooperate closely with health providers to make the prior authorization process smooth and convenient. Anthem’s open communication promotes efficient care for patients.
4. Patient-Centric Approach:
Anthem’s prior authorization policies revolve around patients’ well-being. It guarantees the timely delivery of healthcare services and effective treatment under budget restrictions.
At House of Outsourcing, we handle the complications related to prior authorization requirements. We help the providers meet all these requirements without facing any distractions. We allow the providers to focus on their primary target: delivering quality treatment for patients’ medical intricacies.
How the Anthem Prior Authorization Process Works?
To navigate the Anthem prior authorization smoothly, understanding each step is necessary. Here are gradually developed steps for obtaining Prior Authorization through Anthem services:
1. Provider Submits a Request:
- When a patient approaches health care providers to get specific treatment or medication, providers further proceed to obtain prior authorization for specific cases.
- To submit a successful request, the providers add all relevant details to Anthem about clinical information. The patient’s insurance details and personal details are mentioned in the request form.
2. Anthem Reviews the Request:
- Anthem’s medical team evaluates the request to check the validity and merit.
- To establish guidelines, team members check the policy requirements and adherence to application with prior authorization rules.
- This assessment aims to ensure that evidence-based services delivered to providers and patients can fully facilitate Prior authorization approval.
3. Approval or Denial Decision:
- Approval and denial are obtained after assessing and checking compliance with the rules.
- In case of approval, the providers receive confirmation to proceed with the treatment services.
- Conversely, if the request is denied, the provider receives instructions to take precautionary measures to approve the appeal.
4. Appeals Process:
- In denied applications, providers can take further steps of appeal. In case of administrative denial or treatment denial, providers take corrective action for approval.
- Anthem allows the providers to add required information or clarify the missing points in case of administrative denial.
- The objective of this appeal process is to get transparent and honest outcomes.
Submission Methods for Anthem Prior Authorization
The following platforms can be used to submit prior authorization requests to Anthem:
1. Availity Essentials Platform:
- Anthem’s availability on Availity Essential facilitates the providers to apply for prior authorization.
- Availity Essentials plays a significant role in tracking the application status and applying for prior authorization.
- It connects Anthem with desired providers to deliver medical benefits and to apply for insurance claims.
2. Fax Numbers:
- Providers can call on designated fax numbers to get information related to various services:
- Inpatient authorization (physical health): 877-643-0671
- Inpatient authorization (behavioral health): 866-577-2184
- Outpatient authorization (physical health): 877-643-0672
- Outpatient authorization (behavioral health): 866-577-2183
- Medical injectables: 800-563-5581
- Medicaid prior authorization: 800-964-3627
At Out of Sourcing, all complications related to Anthem’s prior authorization are handled with the cooperation of an expert team. Our professionals guide the providers in request preparation and ensure the application criteria align with the payers’ guidelines. The requests for PA are navigated with extreme transparency and responsibility.
Checking Status and Updates with Anthem
Several supportive steps are used to make updates regarding the request status in the Anthem system:
1. Availity Essentials Platform:
- Availity Essential resources can be used to check the request status.
- Availity is a transparent and efficient platform for communicating with payers.
- After approval or denial, Anthem informs the providers to take steps under the final decision.
2. Interactive Care Reviewer (ICR) Tool:
- With the help of Availity Essential, Anthem allows using the Interactive Care Review tool to clear any objection to authorization requests.
- This tool can be used to check the decisions about PA requests and to submit or attach the requirements to make the approval process fast.
- The ICR tool also helps providers to navigate the challenges of delivering quality patient care.
3. Timely Follow-Up:
- In denial requests, providers should take the required steps on time.
- Contact Anthem’s dedicated prior authorization team if you face a delay in your approval request.
Additional Resources from Anthem
Use Anthem’s resources to make your Prior authorization process faster:
1. Ohio Prior Authorization Requirements:
Providers can submit their requests to Availity Essentials for approval for all medical services.
2. California Prior Authorization Requirements:
- Emergency and family planning services are free from prior authorization requests in California.
- Fax numbers, provider portals and web portals can be used to improve process speedup.
Ohio RISE Program
Youth Behavioral Health
At House of Outsourcing, we deal with the needs of youth behaviour. Our OhioRISE Program is completely introduced to tackle the behaviour challenges of the young generation and children.
Employ billing software:Use advanced billing software for timely, accurate coding and modifiers.
Key Program Highlights:
- Target Audience: Our target audience is youth; handling their behaviour-related health disorders is our prime priority.
- Comprehensive Services: The needed individual receives customized attention courses to come over their behaviour issues. We plan counselling, psychiatric sessions, and therapies for them.
- Collaboration and Coordination: We facilitate the patients by providing clinical needs and identifying the social causes of their health problems. To meet this task effectively, our team works with collaboration between families, community resources and health providers.
- Aetna Better Health of Ohio: To get detailed information about the OhioRISE Program, providers can coordinate with our partner, Aetna Better Health of Ohio.
3. New York Prior Authorization Requirements:
Non-emergency services, bariatric surgery, and special services in New York are provided after prior authorization approval.
4. New York Prior Authorization Lookup Tool:
Anthem Blue Cross and Blue Shield tolls are used to overcome the needs and challenges related to PA requests.
5. Indiana Prior Authorization Requirements:
All elective and routine medical services in Indiana are provided after approval of PA requests. Particular insurance-covered services also need to apply for PA.
At House of Outsourcing, we ensure that providers receive proper information to apply for PA after compliance with Anthem guidelines. Our team assists the healthcare personnel in effectively meeting all challenges of patient care.
Why choose us?
Handling the intricacies of Anthem prior authorization can be overwhelming without proper follow-up. At House of Outsourcing, our team is present to help you with each step. Our aims:
- Precision: Our prior authorization guidelines are prepared by experts, and there is no chance of puzzling questions.
- Guidance: You will get thorough guidelines about Anthem’s criteria for request approval.
- Advocacy: In denial requests, we advocate for the patient’s well-being by making the approval process seamless.
Join us in transforming the approach for prior authorization. Make the whole process easy together and cooperate for patient outcomes. Contact House of Outsourcing today and provide excellent patient care for your patients.
Table of Contents
- A Comprehensive Guide About Anthem Prior Authorization
- Why Anthem Prior Authorization Matters?
- How the Anthem Prior Authorization Process Works?
- Submission Methods for Anthem Prior Authorization
- Checking Status and Updates with Anthem
- Additional Resources from Anthem
- Ohio RISE Program
- Why choose us?
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