Precertification

When You Must Precertify

You must notify Anthem Blue Cross and Blue Shield by calling 1-800-238-2227 (in Connecticut) or 1-800-248-2227 (out-of-state) before receiving any of these services:

• Inpatient stays in a hospital, skilled nursing facility, hospice, subacute care, or acute rehabilitation facility,
• High cost diagnostic imaging services prescribed by an out-of-network provider,
• Organ/tissue transplants.

When To Notify Anthem Blue Cross and Blue Shield

For inpatient stays, you must notify Anthem Blue Cross and Blue Shield of the scheduled admission date at least 24 hours before the start of the hospital stay.

Pregnancy is subject to these notification time periods:

• Non-Emergency Inpatient Hospital Stay Without Delivery of Child: a hospital stay during pregnancy but before the admission for delivery, which isn’t emergency care, requires notification before the admission.
• Inpatient Confinement for Delivery of Child: Anthem Blue Cross and Blue Shield must be notified only if the inpatient care for the mother or child is expected to continue more than 48 hours after a normal vaginal delivery, or more than 96 hours after a cesarean section. For inpatient care (for either mother or child) that continues past these 48/96 hour limits, Anthem Blue Cross and Blue Shield must be notified before the end of these time periods.

Organ/Tissue Transplant Notification

You must notify Anthem Blue Cross and Blue Shield as soon as possible before the scheduled date of any of the following services, or as soon as reasonably possible:

• evaluation,
• donor search,
• organ procurement/tissue harvest, or
• transplant.

Anthem Blue Cross and Blue Shield will then complete the utilization review. You, your doctor, and the facility will receive a letter confirming the results of the review.

Emergency and Urgent Care Notification

When emergency or urgent care is required and results in a hospital admission, you (or your representative or doctor) must call Anthem Blue Cross and Blue Shield within 48 hours of admission.