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Preauthorization Rules Effective March 1, 2011 for Anthem Blue Cross

Feb 15, 2011

Preauthorization for services: access to quality care can save time and money


During these difficult economic times, Anthem Blue Cross knows that you and your clients are conscious of rising health care costs and other costs of doing business.  

Anthem Blue Cross is committed to providing access to high quality health care at the best value. That is why they are making a process change to preauthorization (also known as "preservice review," "pre-certification," "pre-approval," or "prior approval"). 

The plan document specifies which covered services require preauthorization. Starting March 1, 2011, the following categories of outpatient covered services will require preauthorization.  Within these new categories, the following outpatient services specifically require preauthorization as of March 1, 2011: 

Please note that the list of outpatient services under the above categories require preauthorization for dates of service on or after March 1, 2011. This list is subject to change. An amendment to the policy/plan reflecting the changes described in this letter will be sent to your client at their next contract renewal. This is a process change and not a change in coverage.

Preauthorization is not required for the treatment of an emergency condition.

Members may be subject to a monetary penalty or benefits may not be covered for certain services performed without preauthorization,
so it's important they call Anthem Blue Cross to confirm if preauthorization is required. Often times an in-network doctor or health care provider will seek preauthorization for the member. Anthem Blue Cross network providers have been notified of the process change to these new outpatient services. 

This process change applies to many Large Group and Small Group clients (including 51-99 Employee Elect offerings) and their members.

Anthem Blue Cross' commitment to their members means they focus on providing access to high quality and cost- effective healthcare services.

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