Elevance Health (Anthem) Denial Appeal Guide

Elevance Health (formerly Anthem Inc.) is one of the largest health insurers in the US, operating Blue Cross Blue Shield plans in 14 states. Understanding their corporate appeal structure helps navigate denials.

Elevance Health Overview

Elevance Health is the corporate parent of Anthem Blue Cross Blue Shield plans across 14 states. They also operate Carelon (behavioral health), and various Medicaid managed care plans.

Appeal Process

  1. Internal appeal — submit to your local Anthem BCBS plan within 180 days
  2. Second-level review — available in some states
  3. External review — through state external review program
  4. State insurance department — file in your state

Common Denial Reasons

  • Prior authorization required and not obtained
  • Clinical criteria not met (Anthem uses proprietary AIM guidelines for imaging)
  • Step therapy requirements
  • Specialty medication denials (pharmacy benefit managed through IngenioRx)
  • Out-of-network provider

Important: AIM Specialty Health

Elevance uses AIM Specialty Health to manage prior authorization for imaging (CT, MRI, PET), radiation therapy, genetic testing, and other specialty services. Denials from AIM should be appealed through your Anthem plan.

State-Specific Resources

Your appeal rights may vary by state. Check Anthem's website for your specific state plan, or contact your state insurance department for guidance on local appeal procedures and protections.

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Frequently Asked Questions

Is Elevance Health the same as Anthem?

Yes, Anthem Inc. rebranded to Elevance Health in 2022. The individual BCBS plans still operate under the Anthem brand in most states. The appeal process is the same.

What is AIM Specialty Health?

AIM Specialty Health is Elevance's specialty management subsidiary that handles prior authorization for imaging, genetic testing, radiation therapy, and other specialty services. Appeals of AIM denials go through your Anthem plan.

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