Always check benefits through the Voice Response Unit (VRU) or My Insurance Manager^SM 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.

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:
  • Precertification Request 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.