CurrentAnthemPolicy N/A

Request for Authorization: Psychological Testing

A payer-specific authorization request form and instructions for submitting requests for formal psychological testing to Anthem Blue Cross (including Medicare Advantage). It specifies required clinical assessment elements, problems/symptoms, treatment history, rating scales administered, rationale, tests/services requested, and submission methods (Availity or fax). It notes exclusions (placement/forensic and educational testing for school purposes).

Policy Summary

PayerAnthem

PolicyRequest for Authorization: Psychological Testing

Policy CodePolicy N/A

Change TypeAdministrative form / informational

Effective Date

Next Review Date

Key ActionSubmit the completed psychological testing authorization form via Availity or fax (844-430-1703) with required clinical assessment, rating scales, treatment history, rationale, tests/units requested, provider signature and date.

POLICY UPDATE CHANGES

No material clinical or coverage changes

3Explicit excluded request types

MultipleRequired documentation elements

2Submission methods

Policy summary

This is an Anthem Blue Cross (including Medicare Advantage) payer-specific authorization form and instructions to request formal psychological testing. It is used to collect required clinical information to adjudicate requests for testing and to document the clinical assessment elements, treatment history, rating scales administered, rationale for testing, tests/services requested, and provider signature/date.

The form emphasizes that brief behavior rating scales and inventories are routine parts of the diagnostic process and are not sufficient alone to justify formal psychological testing. Except in exceptional cases, a diagnostic interview and all relevant rating scales should be completed by the psychologist prior to submission of a testing request.

Submit the completed form electronically via Availity (https://www.availity.com) or via fax to 844-430-1703. At a high level, the form excludes requests for placement/forensic purposes and educational testing for school-based learning disability evaluation, which should be referred to the public school system.