Anthem Blue Cross and Blue Shield Missouri Prior Authorization Form: A Step-by-Step Guide

Introduction

The prior authorization process for Anthem Blue Cross and Blue Shield Missouri (Anthem BCBS MO) is essential for ensuring that medical treatments, procedures, and medications meet insurance coverage requirements. This guide walks healthcare providers through the step-by-step process of completing and submitting a prior authorization request accurately and efficiently.

What is Prior Authorization?

Prior authorization is a requirement set by Anthem BCBS MO that mandates healthcare providers obtain approval before administering specific medical services. This process helps ensure that treatments are medically necessary and align with Anthem BCBS MO’s coverage policies.

When is Prior Authorization Required?

Anthem BCBS MO requires prior authorization for various medical services, including:

• Advanced imaging (MRI, CT scans, PET scans)
• Specialty prescription medications
• Durable medical equipment (DME)
• Physical and occupational therapy
• Home healthcare services
• Select surgical procedures and treatments

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

Step 1: Download the Prior Authorization Form

Where to get it

Step 2: Provide Patient Information

Accurately enter the patient’s details, including:

• Full name
• Date of birth
• Member ID number
• Contact information

Step 3: Enter Provider Information

The requesting provider must provide:

• Full name and National Provider Identifier (NPI)
• A clinic or hospital name
• Contact details (phone, fax, email)
• Specialty information

Step 4: Specify the Requested Service

Clearly describe the treatment, procedure, or medication requiring authorization, including:

• CPT or HCPCS codes
• ICD-10 diagnosis codes
• Frequency and duration (if applicable)

Step 5: Justify Medical Necessity

Attach necessary supporting documentation, such as:

• Medical history and previous treatments
• Lab results and diagnostic reports
• Treatment plans and expected outcomes
• Clinical guidelines or supporting research studies

Step 6: Submit the Form

Anthem BCBS MO provides multiple submission methods for prior authorization requests:

• Fax: Send to the designated fax number listed on the form
• Online Portal: Submit electronically via the Anthem provider portal
• Phone: Call Anthem BCBS MO provider support for urgent requests

Step 7: Track Your Request

Once submitted, track the status of your request by:

• Logging into the Anthem BCBS MO provider portal
• Contacting provider support
• Monitoring email or fax notifications for approval, additional documentation requests, or denials

Common Reasons for Prior Authorization Denials

To avoid delays, ensure:

• All patient and provider details are accurate
• The request aligns with Anthem BCBS MO’s medical necessity criteria
• Supporting documentation is complete
• The request is submitted within the required timeframe

How Long Does Prior Authorization Take?

Anthem BCBS MO typically processes prior authorization requests within:

• Routine requests: 5-7 business days
• Urgent requests: 24-48 hours

Conclusion

Understanding and following the correct process for submitting an Anthem Blue Cross and Blue Shield Missouri prior authorization form can improve approval rates and minimize delays in patient care. By ensuring accurate information, complete documentation, and timely submission, healthcare providers can navigate the process efficiently.

For additional assistance, visit the Anthem BCBS MO Prior Authorization page or contact provider support.

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