Anthem Blue Cross Blue Shield (Elevance) Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with Anthem Blue Cross Blue Shield (Elevance). Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 30 days standard
- Appeals Address: Anthem Grievance and Appeals, PO Box 27401, Richmond, VA 23279
- Provider Portal: https://www.availity.com/
Why Anthem Denies Prior Authorizations
- 1. Not medically necessary per clinical UM guideline
- 2. Experimental/investigational
- 3. Failure to meet criteria
Clinician Tips for Anthem
- ✓ Anthem uses AIM Specialty Health for high-cost specialty
- ✓ Reference Clinical UM Guideline (CG-) number
- ✓ Submit via Availity portal
Anthem operates in 14 states under the Elevance umbrella.
Anthem Prior Authorization FAQ
Why does Anthem deny prior authorizations?
The most common Anthem denial reasons are: Not medically necessary per clinical UM guideline; Experimental/investigational; Failure to meet criteria.
How long does Anthem take to review a prior authorization?
Anthem typically responds in 30 days standard.
What should a Letter of Medical Necessity for Anthem include?
An LMN for Anthem Blue Cross Blue Shield (Elevance) should reference the specific medical policy or coverage bulletin, document failed first-line therapies with dates, include current labs and ICD-10 codes, and cite supporting clinical guidelines. Anthem operates in 14 states under the Elevance umbrella.