Blue Advantage Pre-service Review (Precertification/Predetermination)

Online Precertification
 

Out-of-state inpatient admissions do not require prior authorization. Blue Advantage follows Medicare guidelines; therefore, if the facility participates with the local Blue plan, claims should be submitted to that plan for payment. For questions regarding network benefits, please contact Provider Customer Service at 1-800-517-6425 (TTY 711), Monday – Friday, 7 a.m. – 6 p.m. Central time.

Submit All Pre-service Reviews Electronically

Electronic pre-service review is available for all services requiring precertification. Submitting electronically instead of fax offers faster, often immediate approvals.

It's important to always check patient eligibility and benefits through your local Blue Plan provider portal or your practice management system. Precertification requirements are subject to change at any time so you should verify benefits for the specific date of service for the service or equipment you will be providing. Learn more about electronic precertification.

Precertification is required for the following services.

• Advanced Imaging Precertification Code List*
• Behavioral Health
• Genetic Testing Precertification Code List*
• Provider-Administered Drugs Precertification Code List*
• Inpatient Hospital
• Inpatient Rehab
• Inpatient Surgical
• Long Term Acute Care
• Occupational Therapy (after 20 visits)
• Physical Therapy (after 20 visits)
• Skilled Nursing Facility
• Speech Therapy (after 20 visits)

Services marked with an asterisk (*) include a designated list of codes or drugs requiring precertification. However, all remaining service categories require precertification.

To request precertification by fax, complete the appropriate form below and fax to the number listed on the form. To initiate precertification by phone, call 1-800-517-6425 (TTY 711), Monday – Friday, 7 a.m. – 6 p.m. Central time.