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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements
View requirements for Local Plan and BlueCard Out-of-Area members.

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Search our online provider directory when you need a doctor, hospital or other health care provider.

Precertification

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Interactive care Reviewer (ICR) - New Precert Tool 
Request outpatient procedures for many members covered by Anthem plans via Availity® at www.availity.com
 
Introducing Interactive Care Reviewer (ICR)
 
ICR FAQs
 
Imaging and Specialty Services Tools -- AIM Specialty Health 
Imaging and Echocardiography Pre-certification CPT Codes

View listing of CPT Codes for Imaging and Echocardiography pre-certification, as well as the Imaging Guidelines for Imaging Pre-certification.

 
MPI or SE Work Sheet

Work sheet will aid in completing web and phone request for Myocardial Perfusion Imaging (MPI) or Stress Echocardiography (SE).

 
Quick Reference Guide to AIM Specialty Health
 
Radiation Therapy Precertification CPT Codes
 
Sleep Management Precertification CPT Codes
 
Specialty Pharmacy Precertification drugs and codes
 
Additional Precertification Information & Tools  
Clinical Data Submission Tools

Printable versions of Anthem's Clinical Data Submission Tools.

 
Clinical Submission Categories
 
Medicare Advantage General Precert form
 
E-Review  
E-Review is a web-based tool that allows providers, clinics and facilities to communicate their request for services via a secured, HIPAA compliant e-mail to/from the associates of the Medical Management departments of Anthem. Using the E-Review process and the submission tools above is an efficient and economical method for precertification and predetermination requests. Contact Medical Management for additional information.  
 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use