Precertification requirements
Determine how to submit certification requests and what services require precertification.
Interactive Care Reviewer (ICR) requests
To request or check the status of a precertification 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.
Behavioral health
Services billed with the following revenue codes ALWAYS require precertification:
0240–0249 — All-inclusive ancillary psychiatric
0901, 0905–0907, 0913 and 0917 — Behavioral health treatment services
0944–0945 — Other therapeutic services
0961 — Psychiatric professional fees
Pharmacy
Services billed with the following revenue codes ALWAYS require precertification:
0632 — Pharmacy multiple sources
Pharmacy precertifications can be requested through Availity.
Pharmacy precertification request by phone
Hours of operation: Monday-Friday, 8 a.m. to 8 p.m.
Pharmacy precertification requests via fax
Retail
844-864-7860
Medical Injectables
888-209-7838
Elective services
Elective services provided by or arranged at nonparticipating facilities always require precertification.
Additional revenue codes
All services billed with the following revenue codes:
0023 — Home health prospective payment system
0570–0572, 0579 — Home health aid
0944–0945 — Other therapeutic services
3101–3109 — Adult day and foster care
Additional precertification request contacts
Precertification requests by phone
Precertification requests may be submitted under Utilization Management, behavioral health, and pharmacy by calling the appropriate phone number for a member's enrollment plan.
Hours of operation: Monday-Friday, 8 a.m. to 8 p.m.
Precertification requests by fax
Submit precertification requests for physical health inpatient and outpatient services
866-406-2803
Submit precertification requests by fax pertaining to concurrent reviews for inpatient, skilled nursing facility, long-term acute care hospital and acute inpatient rehabilitation.
844-765-5156
Carelon services
Submission of clinical documentation as requested by the Anthem Blue Cross and Blue Shield outpatient Utilization Management department to complete medical necessity reviews for outpatient services such as DME, Home Health care, wound care, orthotics, and out-of-network requests should be faxed to CarelonRx at 844-765-5157.
844-765-5157
Interested in becoming a provider in the Anthem network?
We look forward to working with you to provide quality service to our members.
Page last updated 10/17/2025