Elevance Health (parent of Anthem) Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with Elevance Health (parent of Anthem). Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 30 days standard
- Appeals Address: Submit through the local Anthem affiliate plan
- Provider Portal: https://www.elevancehealth.com/
Why Elevance Denies Prior Authorizations
- 1. Clinical UM Guideline criteria not met
- 2. Step therapy
- 3. Site of care
- 4. Specialty pharmacy required
Clinician Tips for Elevance
- ✓ Elevance is the corporate parent — file appeals with the local Anthem plan in your state
- ✓ Reference the Clinical UM Guideline (CG-) number
- ✓ Carelon Medical Benefits (formerly AIM) reviews many specialty drugs
Elevance was rebranded from Anthem Inc. in 2022. The Anthem brand still appears on member ID cards in most markets.
Elevance Prior Authorization FAQ
Why does Elevance deny prior authorizations?
The most common Elevance denial reasons are: Clinical UM Guideline criteria not met; Step therapy; Site of care; Specialty pharmacy required.
How long does Elevance take to review a prior authorization?
Elevance typically responds in 30 days standard.
What should a Letter of Medical Necessity for Elevance include?
An LMN for Elevance Health (parent of Anthem) 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. Elevance was rebranded from Anthem Inc. in 2022. The Anthem brand still appears on member ID cards in most markets.