Connecticut Precertification and Prior Authorization Guidelines

This document is a guide detailing the precertification and prior authorization requirements for Anthem products in Connecticut. It outlines the process by which Anthem determines the medical necessity of selected inpatient and outpatient medical services, including surgeries and major diagnostic procedures. The document specifies that precertification must be obtained prior to the rendering of services to ensure maximum benefits for members. It describes the responsibilities of both participating physicians and members regarding the precertification process, emphasizing the importance of contacting Anthem's Utilization Management Department for authorization. Additionally, the guide includes a list of services requiring prior authorization and notes that the list is subject to change. It also highlights the commitment to appropriate utilization of medical services, stating that decisions made by the utilization management team are based solely on the appropriateness of care and coverage. Overall, the guide serves as a comprehensive resource for understanding Anthem's precertification requirements.