The claim must be received by Carelon within ninety (90) calendar days from the date on the approval letter.īelow is the link to the Retro-Authorization form that needs to be completed and sent to the Clinical Department. If the provider received written approval for the retro-request for service(s) and has not previously submitted a claim, the provider should follow the procedures as outlined in the Carelon Provider Manual for submission of claims adjustments, outlined in Section VI of Claims Payment. Any requests for retro-authorization(s) received beyond forty-five (45) calendar days from the date of service will not be given consideration. The provider will receive written notification within thirty (30) calendar days from Carelon’s receipt of the request, approving or denying the service. Access the evidence-based criteria used in our review process. The request for a retro-authorization only guarantees consideration of the request. Submit a new case for prior authorization, or check on an existing one. The request for retro-authorization must be faxed ( 85) to the attention of the Clinical Department or mailed to the attention of: If, for any reason, the provider finds it necessary to request a retro-authorization for service(s), the request must be received in writing no later than forty-five (45) calendar days from the date of service. The new phone numbers are listed below and will go into effect on April 1, 2022. ![]() To request authorizations: From the Availity home page, select Patient. ![]() Call 1-86 and have available the provider NPI, fax number to receive the fax-back document, member ID number, authorization dates requested, and authorization number (if obtained previously). AIM Specialty Health® (AIM) ® has created a new AIM contact center phone number for providers to use to call in prior authorization requests for Anthem Blue Cross and Blue Shield (Anthem). Call Provider Services at 1-83 from 8 a.m. Providers may also request a fax-back copy of an authorization letter via touch tone telephone. Adverse determination letters and return of incomplete requests will continue to be sent to providers via US Mail. Print the letters or save them to your computer. ![]() Click on the link on the ProviderConnect home page to go to links to new authorization letters. An icon will appear on the ProviderConnect home page indicating that new authorization letters are available. Providers should be able to access authorizations within 2 business days of a decision. Upon receipt of a request for authorization for services, by phone, electronic, or fax transmittal, Carelon has ten (10) business days to enter a provider’s authorization.
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