Blue cross blue shield prior authorization fax number

Q: What is the prior authorization process?

Prior authorization (also called preauthorization” and precertification”) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided. This allows the plan to evaluate whether care is medically necessary and otherwise covered.

Q: Does BCBS of Texas require prior authorization?

Prior authorization (PA) may be required via BCBSTXs medical management, eviCore® healthcare, AIM specialty Health® or Magellan Healthcare®. You can review how to submit PA or Notification requests and view PA statistical data here.

ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call 1-800-200-4255 (TTY: 711).

Table of Contents Show

Responsibility for Requesting Prior Review and Certification
For In-Network Providers
For Out-of-Network Providers
Why is prior review and certification necessary?
What types of procedures may require prior review and certification?
How can my provider request prior review and certification?
How do you get a prior authorization number?
What is the prior authorization process?
What form do providers in California use to request prior authorization?
Does BCBS of Texas require prior authorization?

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-200-4255 (TTY: 711 ).

ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID chamar 1-800-200-4255 (TTY: 711 ).

ATTENTION : si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Appelez le Service adhérents au numéro indiqué sur votre carte d’assuré appel 1-800-200-4255 (TTY : 711 ).

注意：如果您讲中文，我们可向您免费提供语言协助服务。请拨打您 ID 卡上的号码联系会员服务部通话 1-800-200-4255（TTY 号码：711 )。

ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-200-4255 TTY: 711 ).

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ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов 1-800-200-4255 (телетайп: 711 ).

ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្ រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ វាសមា ជិកតាមល េខន ៅល. ើប ័ណ្ណ សម្ គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ 1-800-200-4255 (TTY: 711) ។

ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata 1-800-200-4255 (TTY: 711 ).

참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-200-4255 (TTY : 711)로 회원 서비스에 연락하십시오.

ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας υπηρεσίες γλωσσικής βοήθειας, δωρεάν. Καλέστε την Υπηρεσία Εξυπηρέτησης Μελών στον αριθμό της κάρτας μέλους σας (ID Card) κλήση 1-800-200-4255 (TTY: 711 ).

UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej. Należy zadzwonić do Działu obsługi ubezpieczonych pod numer podany na identyfikatorze zadzwoń 1-800-200-4255 (TTY: 711 ).

ध्यान दें: य दि आप ह िन् दी बोलते ह ैं, तो भा षा सहाय ता सेवा एँ, आप के लि ए नि :शुल्क उपलब्ध ह ैं। सदस्य सेवा ओं को आपके आई.डी. कार ्ड पर दि ए गए नंबर पर कॉल करें कॉल 1-800-200-4255 ( टी .टी .वा ई.: 711).

ધ્યાન આપો: જો તમે ગુજરા તી બોલતા હો, તો તમને ભા ષા કીય સહાય તા સેવા ઓ વિ ના મૂલ્યે ઉપલબ્ધ છે. તમા રા આઈડી કાર ્ડ પર આપેલા નંબર પર Member Service ને કૉલ કરો કૉલ કરો 1-800-200-4255 (TTY: 711).

PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-200-4255 (TTY: 711 ).

お知らせ：日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください呼び出す 1-800-200-4255（TTY: 711 ）。

ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-200-4255 (TTY: 711 ).

ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-200-4255 (TTY: 711).

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Certain services require prior review and certification from Blue Cross NC before they can be covered by your health insurance plan.

Responsibility for Requesting Prior Review and Certification

For In-Network Providers

North Carolina providers or specialists in the Blue Cross NC network will request prior review for you. You may want to check with your health care provider to make sure that prior review was obtained before you have the service or procedure in question.

For Out-of-Network Providers

You are responsible for ensuring that out-of-network doctors have requested prior review and certification from Blue Cross NC before the service is performed. The physician or her office should request the review from Blue Cross NC. This also applies to BlueCard® providers (out of state providers who contract with another Blue Cross Blue Shield plan) outside of North Carolina. Your Benefit Booklet has more information about prior review and certification that is specific to your policy.

Prior review and certification is also known as:

Prior plan approval
Prior authorization
Prospective review
Certification
Precertification

In case of emergency, prior review and certification is NOT required. Blue Cross NC should be notified of an urgent or emergency admission by the second business day of the admission.

Prior review and Certification Code list:

This list is provided for member information only. It is a provider tool and is updated on a quarterly basis, within the first 10 days of January, April, July, and October. If there is no update within this time period, the list will remain unchanged until the following quarter.

Prior Review and Certification Code List

Why is prior review and certification necessary?

Prior review and certification ensures that:

Your benefits cover the service in question
The service is medically necessary according to Blue Cross NC medical policy
The service is performed in the right health care setting
The provider is correctly identified as in- or out-of-network
Special medical circumstances are identified that require specific types of review and follow-up

Note: Blue Cross NC may certify a service received out-of-network at the in-network benefit level if the service is not reasonably available in-network or if there is a continuity of care issue.

What types of procedures may require prior review and certification?

Whether prior review and certification is required may depend on your Blue Cross NC benefit plan. Always check your Benefit Booklet for specific information about your plan. The following procedures typically require prior review and certification:,

Inpatient admissions (with the exception of maternity admissions) — elective, planned in advance or not related to an emergency.
Inpatient maternity stays longer than 48 hours after vaginal delivery or 96 hours after a C-section
Private duty nursing, skilled nursing facility, acute rehabilitation admissions (short-term inpatient recovery), home health care (including nursing and some home infusion).
Services performed by an out-of-network or non-BlueCard® out-of-state health care provider
Air ambulance services (emergency air ambulance does not require prior review)
Certain durable medical equipment (DME)
Transplants — solid organ (e.g. liver) or bone marrow/stem cell
Surgery and/or outpatient procedures

How can my provider request prior review and certification?

Your health care provider can use any of the following ways to request prior review and certification:

By phone: Blue Cross NC Utilization Management at 1-800-672-7897 Monday to Friday, 8 a.m. — 5 p.m. ET
By fax: Request form

How do you get a prior authorization number?

If a PA is needed, locate the process for submitting and obtain any required prior authorization forms. This information is typically found on the plan's website, or you may call the member services number found on the back of your insurance card.

What is the prior authorization process?

Prior authorization (also called “preauthorization” and “precertification”) refers to a requirement by health plans for patients to obtain approval of a health care service or medication before the care is provided. This allows the plan to evaluate whether care is medically necessary and otherwise covered.

What form do providers in California use to request prior authorization?

Providers must request CCS services using a SAR form. Note: Providers should verify CCS eligibility before submitting a SAR. Providers are required to submit documentation to substantiate medical necessity at the time the SAR is submitted.

Does BCBS of Texas require prior authorization?

Prior authorization (PA) may be required via BCBSTX's medical management, eviCore^® healthcare, AIM specialty Health^® or Magellan Healthcare^®. You can review how to submit PA or Notification requests and view PA statistical data here.

blue cross blue shield prior authorization fax number