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).
No material clinical or coverage changes
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.
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