Anthem dme prior auth fillable form 2025

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Prior authorization from Anthem is necessary for initial coverage of Ozempic.
Thats our Anthem. Our Medicaid and low-cost insurance plans are made with Anthem HealthKeepers Plus members in mind. No matter your age or health goals, were with you every step of the way.
Anthem is a registered trademark of Anthem Insurance Companies, Inc. Anthem HealthKeepers Plus, offered by HealthKeepers, Inc., is a health plan that contracts with the Virginia Department of Medical Assistance Services to provide Medicaid benefits to enrollees.
For all other precertification requests (including all elective inpatient or outpatient services), please fax to: 1-800-964-3627.
Written reconsiderations To submit a written reconsideration, use a blank Claim Information/Adjustment Request 151 Form, available online at Claims Forms. Once the form is complete, attach any necessary information and mail it to: HealthKeepers, Inc.
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People also ask

Who needs the Anthem HealthKeepers Plus Pharmacy Prior Authorization Form? Patients requiring new medications under Medicaid must complete this form for authorization. Healthcare providers need to submit this form to request medication approvals for their patients.
Prior authorization (prior auth, or PA) is a management process used by insurance companies to determine if a prescribed product or service will be covered. This means if the product or service will be paid for in full or in part.
Call Member Services at 800-901-0020 (TTY 711).

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