Anthem Blue Cross and Blue Shield Colorado Prior Authorization Form: A Step-by-Step Guide

Introduction

Navigating the Anthem Blue Cross and Blue Shield Colorado (Anthem BCBS CO) prior authorization process is essential for healthcare providers to ensure that medical services, treatments, and prescriptions are covered under a patient’s plan. Submitting an accurate and complete prior authorization form can prevent claim denials and delays in patient care.

This step-by-step guide will walk you through the prior authorization process, required documentation, submission methods, and tips for successful approval.

What is Prior Authorization?

Prior authorization (PA) is a requirement by Anthem BCBS Colorado for certain medical treatments, procedures, and prescription drugs. Providers must obtain pre-approval to confirm that the service is medically necessary and covered under the patient's health insurance plan.

When is Prior Authorization Required?

Anthem BCBS Colorado requires prior authorization for a variety of medical services, including:

1. Advanced imaging services (MRI, CT scans, PET scans)
2. Specialty prescription drugs
3. Durable medical equipment (DME)
4. Physical therapy and rehabilitation services
5. Behavioral and mental health treatments
6. Home healthcare services
7. Outpatient and inpatient surgical procedures

Failure to obtain prior authorization may result in claim denials or higher out-of-pocket costs for patients.

Step-by-Step Guide to Completing the Anthem BCBS Colorado Prior Authorization Form

Step 1: Download the Prior Authorization Form

Where to get it

Step 2: Provide Patient Information

Ensure all patient details are accurate, including:

1. Full Name
2. Date of Birth
3. Member ID Number
4. Patient Contact Information

Step 3: Enter Healthcare Provider Information

The requesting provider must include the following:

1. Physician or Facility Name
2. National Provider Identifier (NPI) Number
3. Clinic or Hospital Name
4. Provider’s Specialty
5. Phone, Fax, and Email Contact Information

Step 4: Specify the Medical Service Request

Clearly state the treatment, procedure, or medication requiring prior authorization. Include:

1. CPT or HCPCS Codes
2. ICD-10 Diagnosis Codes
3. Requested Service Date
4. Duration and Frequency of Treatment

Providing correct medical codes ensures faster processing of the prior authorization request.

Step 5: Attach Supporting Medical Documentation

To justify medical necessity, providers must include supporting documents such as:

1. Medical History & Progress Notes
2. Lab Results and Imaging Reports
3. Treatment Plan and Expected Outcomes
4. Details of Previous Treatment Attempts & Failures

Comprehensive medical documentation increases the likelihood of approval.

Step 6: Submit the Prior Authorization Form

Providers can submit prior authorization requests through multiple channels:

1. Online Submission

Use the Anthem BCBS Colorado Provider Portal for the fastest processing.

2. Fax Submission

Fax the completed form to the designated Anthem BCBS Colorado fax number found on the form.

3. Phone Submission

Call the Anthem BCBS Colorado Provider Services line for urgent requests.

Step 7: Track the Prior Authorization Request

After submission, providers can track the prior authorization status through:

1. Anthem BCBS Colorado Provider Portal
2. Phone Inquiry via Provider Services
3. Fax or Email Notifications

Monitoring the request status helps avoid delays and allows providers to respond to any additional document requests.

Common Reasons for Prior Authorization Denials

To prevent delays or denials, ensure:

1. The form is correctly filled out with accurate patient and provider details.
2. Medical necessity documentation is attached.
3. The request aligns with Anthem BCBS Colorado’s coverage policies.
4. The submission is made before the procedure date.

How Long Does Prior Authorization Take?

Anthem BCBS Colorado follows these processing timeframes:

1. Routine Requests: Typically processed within 5-7 business days.
2. Urgent Requests: Expedited within 24-48 hours.

Submitting requests early prevents treatment delays.

Conclusion

Understanding the Anthem BCBS Colorado prior authorization process helps healthcare providers submit accurate and complete requests, reducing the risk of claim denials and treatment delays.

By following the correct submission steps, providing detailed medical documentation, and using the appropriate submission methods, providers can streamline approvals and ensure better patient care.

For additional details, visit the Anthem BCBS Colorado Prior Authorization page or contact provider support.