Introduction

Navigating the Anthem Blue Cross and Blue Shield Connecticut (Anthem BCBS CT) prior authorization process is crucial for healthcare providers to ensure that medical services, treatments, and prescriptions are covered under a patient’s plan. Submitting a complete and accurate prior authorization form can prevent claim denials and treatment delays.

This step-by-step guide provides everything you need to know about Anthem BCBS CT’s prior authorization process, including required documentation, submission methods, and approval tips.

What is Prior Authorization?

Prior authorization (PA) is a process required by Anthem BCBS Connecticut for specific medical services, treatments, and prescription drugs. It ensures that the requested treatment is medically necessary and falls under the patient’s insurance coverage.

When is Prior Authorization Required?

Anthem BCBS CT requires prior authorization for various healthcare services, including:

1. Advanced diagnostic imaging (MRI, CT scans, PET scans)
2. Specialty medications and high-cost prescriptions
3. Durable medical equipment (DME)
4. Physical therapy and rehabilitation services
5. Behavioral health and mental health treatments
6. Home healthcare services
7. Elective surgeries and inpatient admissions

Failure to obtain prior authorization may lead to claim denials or higher out-of-pocket costs for patients.

Step-by-Step Guide to Completing the Anthem BCBS Connecticut Prior Authorization Form

Step 1: Download the Prior Authorization Form

Where to get it

Step 2: Provide Patient Information

Ensure accurate patient details, including:

1. Full Name
2. Date of Birth
3. Member ID Number
4. Patient Contact Information

Step 3: Enter Healthcare Provider Information

The requesting provider must include:

1. Physician or Facility Name
2. National Provider Identifier (NPI) Number
3. Clinic or Hospital Name
4. Provider’s Specialty
5. Phone, Fax, and Email Contact Information

Step 4: Specify the Medical Service Request

Clearly state the procedure, treatment, or medication requiring prior authorization. Include:

1. CPT or HCPCS Codes
2. ICD-10 Diagnosis Codes
3. Service Start Date
4. Treatment Frequency and Duration

Providing accurate medical codes ensures faster processing of the prior authorization request.

Step 5: Attach Supporting Medical Documentation

To justify medical necessity, providers must submit supporting documents such as:

1. Medical History & Progress Notes
2. Lab Test Results and Imaging Reports
3. Treatment Plan and Expected Outcomes
4. Previous Treatment Attempts & Justification for New Request

Comprehensive documentation increases the likelihood of approval.

Step 6: Submit the Prior Authorization Form

Providers can submit prior authorization requests through multiple channels:

1. Online Submission

Use the Anthem BCBS Connecticut Provider Portal for the quickest processing.

2. Fax Submission

Fax the completed form to the Anthem BCBS Connecticut fax number provided on the form.

3. Phone Submission

Call the Anthem BCBS Connecticut Provider Services for urgent requests.

Step 7: Track the Prior Authorization Request

After submission, providers can track the prior authorization status through:

1. Anthem BCBS CT Provider Portal
2. Phone Inquiry via Provider Services
3. Fax or Email Notifications

Tracking the request status allows providers to respond promptly to additional documentation requests.

Common Reasons for Prior Authorization Denials

To avoid denials and delays, ensure:

1. The form is filled out correctly with accurate patient and provider details.
2. The medical necessity documentation is complete and attached.
3. The request complies with Anthem BCBS Connecticut’s coverage policies.
4. The submission is made before the procedure date.

How Long Does Prior Authorization Take?

Anthem BCBS Connecticut follows these processing timelines:

1. Routine Requests: Processed within 5-7 business days.
2. Urgent Requests: Expedited within 24-48 hours.

Submitting prior authorization early helps prevent treatment delays.

Conclusion

Understanding the Anthem BCBS Connecticut prior authorization process allows healthcare providers to submit accurate and complete requests, reducing the risk of claim denials and treatment delays.

By following the correct submission steps, providing comprehensive documentation, and using the correct submission methods, providers can ensure efficient approval and improved patient care.

For further details, visit the Anthem BCBS Connecticut Prior Authorization page or contact provider support.