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. Anthem Blue Cross and Blue Shield Medicaid (Anthem) is available via phone or the ICR 24 hours a day, 7 days a week to accept prior authorization (PA) requests. You
can access the ICR from the Availity home page:
Prior authorization contact information for Anthem
Providers and staff can also contact Anthem for help with prior authorization via the following methods:
Provider Services:
Hours: Monday to Friday from 8 a.m. to 6 p.m. ET (Interactive Voice Response (IVR) System available 24 hours a day, 7 days a week
Phone:
1-855-661-2028
Fax:
1-800-964-3627
Pharmacy department
Hours: Monday to Friday from 8 a.m. to 6 p.m. ET
Phone:
1-855-661-2028
Retail pharmacy fax:
1-844-879-2961
Medical injectables fax:
1-844-487-9289
Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid.
Provider tools & resources
- Log in to Availity
- Learn about Availity
- Prior Authorization Lookup Tool
- Prior Authorization Requirements
- Claims Overview
- Reimbursement Policies
- Provider Manuals, Policies & Guidelines
- Referrals
- Forms
- Provider Training Academy
- Pharmacy Information
Interested in becoming a provider in the Anthem network?
We look forward to working with you to provide quality services to our members.
California
Provider Communications
Updated prior authorization form for providers
Dec 1, 2018 • State & Federal / Medi-Cal Managed Care
As of October 1, 2018 you should be utilizing the new Anthem Blue Cross (Anthem) prior authorization form for Medi‑Cal Managed Care and L.A. Care members.
You will be happy to know that we have added additional requirements to make it easier for you when submitting prior authorization requests. This will help in a faster turn-around-time and will help us in servicing you better.
Additional requirements added include:
- A checkbox for the provider to choose between an initial request and a continuation.
- Fields for both physicians and facilities: servicing physician/facility name, tax ID/Medicare number, NPI, address, phone number and fax number.
Acquire an Anthem prior authorization form via web, phone or fax:
- Web: Access the form directly at //mediproviders.anthem.com/ca Provider Support > Forms > Prior Authorization Forms > Request for Preservice Review.
- Phone: Call 1‑888‑831‑2246, option 3 and ask for a form to be faxed to you.
- Fax: Send your request to: 1-800-754-4708.
Featured In:
December 2018 Anthem Blue Cross Provider Newsletter - California
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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?
Participating and Nonparticipating Durable Medical Equipment Providers
For durable medical equipment (DME), outpatient rehabilitation (physical therapy/occupational therapy/speech therapy), pain management, home care, home infusion or hyperbaric treatment, and wound care, please fax to 1-866-920-8362.
Please fax to:
Fax:
1-866-920-8362
All Other Precertification Requests (Including Elective Inpatient or Outpatient Services) use the following:
Fax:
1-800-964-3627
Phone:
1-844-396-2330
Behavioral health
Services billed with the following revenue codes always
require prior authorization: The following always require precertification:Pharmacy
0632
Pharmacy multiple sources
Medicare and long-term services and supports
0023
home health prospective payment system
0570-0572 and 0579
home health aide
0944–0945
other therapeutic services
3101-3109
adult day and foster care
Related information
Provider tools & resources
- Log in to Availity
- Learn about Availity
- Precertification Lookup Tool
- Precertification Requirements
- Claims Overview
- Member Eligibility & Pharmacy Overview
- Provider Manuals and Guides
- Referrals
- Forms
- Training Academy
- Pharmacy Information
- Electronic Data Interchange (EDI)
Interested in becoming a provider in our network?
We look forward to working with you to provide quality services to our members.