Prior Authorization
Always check benefits through the Voice Response Unit (VRU) or My Insurance ManagerSM to determine if prior authorization is required.
Many of our plans require prior authorization for certain procedures and durable medical equipment. This process allows us to check ahead of time whether services meet criteria for coverage by a member’s health plan.
In many cases, approval is instant. When it’s not, we’ll review your request, taking into account:
- Our medical policies
- Recognized clinical guidelines
- Out-of-area patients (BlueCard®)
- The terms of the member’s benefit plan
Some requests may require additional documentation.
Review the standard prior authorization list to get an idea of which services typically require prior approval. This list is not all inclusive and is subject to change. It is a guide that includes the most commonly requested services requiring a medical review.
Prior authorization for medical services
When you request prior authorization from us, we want the process to be fast, easy and accurate. We offer these convenient options:
- Medical Forms Resource Center (MFRC) – This online tool makes it easy to submit prior authorization requests for certain services. The tool guides you through all of the forms you need so you can avoid follow-up calls for additional information.
- My Insurance Manager – You also can submit prior authorization using the same online self-service provider tool you can use to check eligibility, manage claims and more.
- Fax – If you would prefer to submit your request by fax, complete and follow the submission directions on this form:
Prior authorization for behavioral health services
A few plans may continue to require prior authorization for behavioral health services to include applied behavioral analysis (ABA) therapy. To request prior authorization, contact Companion Benefits Alternatives (CBA) using one of the below options:
- Calling
800-868-1032 - Forms Resource Center – This online tool makes it easy for behavioral health clinicians to submit behavioral health prior authorization requests. The tool guides you through all of the forms you need so you can avoid follow-up calls for additional information.
CBA is a separate company that administers mental health and substance abuse benefits on behalf of BlueCross.
These services require prior authorization through third party vendors.
Laboratory Medical Benefits Musculoskeletal Care Nonspecialty Medications Radiation Oncology Radiology Specialty Medical MedicationsThese resources are available for prior authorization through BlueCross.
BlueCard Prior Authorization/Medical Policies Medical Forms Resource Center My Insurance Manager Authorizations FAQsMedicare Advantage: View the prior authorization requirements exclusively for our Medicare Advantage plans here.