Tip for Anthem Referral (plan-specific)

Confirm whether the specialist is in-network with Anthem/BCBS to avoid balance billing

Tip for Anthem Referral (plan-specific)

Request enough authorized visits for the expected course of treatment

Tip for Anthem Referral (plan-specific)

Some Anthem plans do not require referrals — verify your specific plan requirements

InsuranceeasyDoctor signature required

Anthem/BCBS Referral Authorization Form

Anthem Referral (plan-specific) · Anthem / Blue Cross Blue Shield

Anthem/BCBS-specific referral authorization form for specialist visits and out-of-network services. Documents the referring provider, specialist, clinical reason, and number of authorized visits.

Form Details

Total fields: 10
Auto-fillable: 7 (70%)
Time without BeneFill: 12 minutes
Time with BeneFill: 3 minutes
Time saved: 9 minutes
Filled by: both
Frequency: per incident

Fill this form with BeneFill

Auto-fill 70% of fields from your profile. Save 9 minutes. Download a real PDF.

7 of 10 fields70% auto-filled

Start Filling Upload Your Copy Instead

Where to Submit This Form

🌐

Anthem Provider Portal (Availity)

https://www.availity.com/

Submit referral requests electronically.

📠

Fax to Anthem Referral Department

Fax number varies by state — check the provider manual for your state's number.

Filing Deadline

Submit before the specialist visit. Referrals are typically valid for 60-90 days depending on the plan.

Required Attachments

📎 Completed referral authorization form
📎 Clinical justification for the specialist referral
📎 Relevant test results or treatment history

Processing Time

Standard: 5-10 business days. Urgent: 24-72 hours.

What Happens Next

A referral authorization number is issued and shared with the specialist's office. Verify the referral is on file with both the specialist and Anthem before your visit.

Tips for This Form

✓ Confirm whether the specialist is in-network with Anthem/BCBS to avoid balance billing
✓ Request enough authorized visits for the expected course of treatment
✓ Some Anthem plans do not require referrals — verify your specific plan requirements
✓ If the referral is denied, ask about the appeals process or an alternative in-network specialist

More Insurance Forms

Medical Services Prior Authorization Request

PA Request (insurer-specific) · Health Insurance Plans

Request for approval of surgical procedures, imaging studies, specialist referrals, or other services requiring pre-authorization. Must demonstrate medical necessity.

Pharmacy Prior Authorization Request

Pharmacy PA (insurer/PBM-specific) · Health Insurance Plans / PBMs

Request for coverage of formulary drugs requiring PA, non-formulary drugs, or override of step therapy, quantity limits, or other utilization management edits.

Step Therapy Exception Request

Step Therapy Exception · Health Insurance Plans / PBMs

Request to bypass step therapy requirement and proceed directly to a preferred or non-preferred drug. Must document why first-step drugs are not appropriate for the patient.

Tiering Exception Request

Tiering Exception · Part D Plans / Commercial Insurers

Request to obtain a non-preferred drug at the lower cost-sharing tier. Prescriber must provide a supporting statement documenting why the lower-tier alternatives are not appropriate.

Specialty Drug Prior Authorization

Specialty PA (insurer-specific) · Health Insurance Plans / Specialty Pharmacies

Prior authorization request for high-cost specialty medications including biologics, gene therapies, and other complex drugs. Requires detailed clinical criteria documentation.

DME Prior Authorization Request

DME PA (insurer-specific) · Health Insurance Plans / Medicare MACs

Request for coverage of wheelchairs, CPAP machines, hospital beds, prosthetics, orthotics, and other durable medical equipment.

Not sure which forms you need?

Tell our assistant about your situation and we'll find the right forms for you.

Chat with Form Assistant

Disclaimer: BeneFill™ provides form-filling assistance and informational guidance only. It is not affiliated with, endorsed by, or sponsored by the Anthem / Blue Cross Blue Shield or any government agency. The information provided is for general informational purposes and does not constitute legal, medical, financial, or tax advice. Always verify form requirements and submission details directly with the issuing agency.