800 964 3627-2025

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The document is a provider update from Amerigroup District of Columbia, Inc. detailing the precertification request process for prior authorization. It includes instructions for completing the request form with necessary member and provider information, types of services, and additional clinical documentation required to prevent processing delays. The document also specifies different service categories and emphasizes the importance of providing accurate details for emergent or urgent admissions.

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Click ‘Get Form’ to open the 800 964 3627 document in the editor.
Begin by entering today’s date at the top of the form. This helps track when the request was made.
Fill in the member information section, including first name, last name, address, date of birth, and Amerigroup member ID. Ensure all details are accurate to prevent processing delays.
Complete the referring provider section with full name, NPI, office contact name, address, and specialty. Repeat this for the servicing provider and facility sections as well.
Indicate whether you are a participating or nonparticipating provider by checking the appropriate box and providing your Provider ID and TIN.
In the requested service section, check all applicable types of services and provide relevant ICD-10 and CPT codes along with requested units.
Finally, add any additional information that may support your request before submitting it through our platform.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (85 Votes)
2017	4.1 Satisfied (35 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for Empire prior authorization?

For PA requests by phone or for questions, call Provider Services at 1-800-450-8753. Please allow Empire BlueCross BlueShield HealthPlus at least 24 hours to review this request.

What is a pre-authorization phone number?

A number, code, or other value that indicates the services provided on this claim have been authorized by the payee or other service organization, or that a referral for services has been approved. (Also called Prior Authorization or Referral Number).

Is Empire the same as Blue Cross Blue Shield?

As of January 1, 2024, the Empire BlueCross BlueShield and Empire BlueCross names are Anthem Blue Cross and Blue Shield and Anthem Blue Cross. This will not impact your coverage, access to care, or level of support. Want to know more about Anthem?

What is the phone number for Blue Shield promise authorization?

If you have questions related to Blue Shield Promise medical or pharmacy authorizations, contact Provider Services at (800) 468-9935.

What is the phone number for Anthem BCBS of Virginia prior authorization?

Please note, this communication applies to Anthem HealthKeepers Plus Medicaid products offered by HealthKeepers, Inc. HealthKeepers Inc. prior authorization: 800-901-0020 Fax: 800-964-3627 To prevent delay in processing your request, please fill out form in its entirety with all applicable information.

What is the phone number for the Empire Plan prior authorization?

For assistance with either program, call The Empire Plan at 1-877-7-NYSHIP (1-877-769-7447).

What is the phone number for Empire BCBS prior authorization?

For PA requests by phone or if you have questions, call Provider Services at 800-450-8753. Please allow Empire BlueCross BlueShield HealthPlus at least 24 hours to review this request.