Precertification Requirements

Submit precertification requests

Anthem accepts precertification requests via Availity Essentials or, if you prefer paper submissions, via phone or fax.

To request or check the status of a precertification request or decision for a particular plan member, log in to Availity Essentials and select Patient Registration and then select Authorizations & Referrals.

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Durable medical equipment (DME) providers

For participating and non-participating 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 precertification requests to 866-920-8362.

Fax: 866-920-8362

All other precertification requests (Including elective inpatient or outpatient services) may be faxed to 800-964-3627 or you can call in precertification requests to 844-396-2330.

Fax: 800-964-3627

Call: 844-396-2330

Behavioral health

Please submit all precertification requests using Availity Essentials.

Behavioral health revenue codes

Services billed with the following revenue codes always require precertification:

0240–0249 — all-inclusive ancillary psychiatric

0901, 0905–0907, 0913, 0917 — behavioral health treatment services

0944–0945 — other therapeutic services

0961 — psychiatric professional fees

Pharmacy

Please refer to the Preferred Drug List (PDL) when prescribing for our members. Though most medications on the PDL are covered without precertification, a few agents require you to contact the Pharmacy department for authorization.

Call the pharmacy department: 844-396-2330

Available 8 a.m. to 7 p.m. Monday through Friday;
10 a.m. to 2 p.m. Saturday

Retail pharmacy fax requests: 844-490-4874

Medical injectable fax requests: 844-490-4876