Anthem Connecticut Introduces New Prior Auth Pass Program

August 2019 ~

Anthem is has rolled out a new prior authorization program, designed to reduce the administrative burden associated with current prior authorization (PA) processes for providers who are contracted with Anthem in Connecticut.

According to the insurer, the Prior Auth Pass Program will allow providers who meet program requirements to waive prior authorization for select outpatient medical procedures that generally have high rates of PA requests and approvals.

Providers that meet all program criteria and agree to participate in the Prior Auth Pass

Program will no longer need to submit a request for a PA decision for a predetermined list of common medical procedures. These providers will only need to verify that the patient is an Anthem member that is currently receiving services (within the state) before providing the eligible service(s). (NOTE: Exceptions include BlueCard Host members, Federal Employee Program members, New York State and New York City employees.)

Current criteria for participation in Anthem’s Prior Auth Pass Program are as follows:

  • Participation in the Cooperative Care value-based program, which includes meaningful shared risk for their Commercial patient population.
  • Demonstration of historically high prior authorization approval rates of 90% or greater for program procedure codes.
  • Commitment to Anthem’s back-end monitoring process to manage under- and overutilization.
  • Having technical system capabilities in place to allow for timely adoption and implementation.

Providers with questions about fulfilling the criteria and participating in the Prior Auth Pass Program should contact CTNetworkManagement-SM@anthem.com.

 

 

Source(s): August 2019 Anthem Connecticut Provider News;

 

 

AdvantEdge