Anthem Blue Cross Blue Shield is one of the largest health insurance companies in the U.S., serving over 45 million members across 14 states. Anthem prior authorization requirements vary by state and plan but generally require PA for advanced imaging, elective surgeries, and specialty medications.
Anthem uses the Availity portal as its primary provider transaction platform for prior authorization submissions, eligibility verification, and claim status inquiries. Some Anthem plans also accept PA submissions through their own provider portal.
Anthem BCBS requires prior authorization for advanced diagnostic imaging, many outpatient procedures, specialty drugs, and certain office-based services. They use AIM Specialty Health (now part of Anthem) for imaging utilization management and apply InterQual or proprietary criteria for medical/surgical reviews.
Anthem uses AIM Specialty Health for managing advanced imaging prior authorizations. Clinical criteria must be met for MRI, CT, PET, and nuclear medicine studies. Anthem's imaging PA requirements can vary significantly by state and plan, so providers should always verify requirements for the specific member.
Check whether the member's plan uses AIM Specialty Health or a different utilization management vendor.
Submit PA requests at least 5-7 business days before the scheduled procedure to account for review time.
Include all relevant clinical notes, prior imaging results, and conservative treatment history.
Anthem PA requirements vary by state. Verify the specific state plan requirements.
Use Availity for electronic PA submissions to get faster turnaround times.
For denied requests, the peer-to-peer review process with Anthem is often effective for overturning decisions.
Greenlight Medical submits prior authorizations directly to Anthem Blue Cross Blue Shield, assembles all required documentation, and tracks status in real time. No portal logins, no phone holds, no fax machines.
See Greenlight in ActionPA requests can be submitted through Availity, the Anthem provider portal, or by phone/fax. For imaging, requests route through AIM Specialty Health. Greenlight Medical automates the submission to the correct Anthem channel based on the service type and member plan.
Yes, Anthem generally requires prior authorization for MRI studies through AIM Specialty Health. The clinical criteria and documentation requirements vary by body part and clinical indication. Some screening MRIs (like breast MRI for high-risk patients) may have different requirements.
Anthem typically processes standard PA requests within 3-5 business days. Urgent requests may be reviewed within 24-48 hours. Electronic submissions through Availity tend to be processed faster than phone or fax submissions.
Many CT scans require prior authorization through Anthem, especially CT with contrast and advanced studies like CT angiography. Requirements vary by plan and state. Routine low-dose CT lung screenings may have a separate pathway.