To obtain medical precertification members should contact the Anthem Blue Cross Blue Shield precertification area at 1-866-776-4793.
Precertification may be required for the following services (not all-inclusive):
- Inpatient Care provided under the Plan with the exception of maternity admissions. Please note: In case of an emergency care admission, the member must notify Anthem BCBS within two business days after the admission.
- Maternity and/or Newborn Inpatient Care beyond 48 hours for a normal delivery or 96 hours for a cesarean section.
- Certain Diagnostic Testing.
- The purchase, rental, repair, or replacement of Durable Medical Equipment.
- Outpatient surgery and other outpatient treatment at Hospitals and Ambulatory Surgery Facilities.
- Human Organ and Bone Marrow/Stem Cell Transplants.
- Mental Health and Substance Abuse Benefits for Acute Inpatient Admissions, Transcranial Magnetic Stimulations, Residential Care, Behavioral Health In-Home Programs, Applied Behavioral Analysis, Intensive Outpatient Therapy, and Partial Hospitalization.
- Air ambulance (excludes 911-initiated emergency transport).
- Private Duty Nursing.
- Radiation Therapy.
Precertification is also required for High Tech Imaging Services, such as CT scans, PET scans, and MRIs. Contact Anthem BCBS at 1-888-953-6703.
Precertification is also required for Specialty Drug treatment through the medical plan. Contact Anthem BCBS at 1-833-293-0659.
If you are unsure if a service needs precertification, feel free to contact the Anthem customer service area at 1-877-512-7875 to inquire if precertification is needed for a specific service or procedure.