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.
How to Request Prior Authorization
When you request prior authorization from us, we want the process to be fast, easy and accurate. We offer a single sign-on through My Insurance Manager so you can begin the process for medical services.
For behavioral health services, use the Forms Resource Center to being the prior authorization process.
Resources
- BlueCard Prior Authorization Tool (Out-of-State Members)
- Prior Authorization Frequently Asked Questions
Medicare Advantage: View the prior authorization requirements exclusively for our Medicare Advantage plans.