Clarifying authorization requirements for Blue Cross members

We are receiving authorization requests through the e-referral system for Blue Cross PPO (commercial) members that do not need to be submitted.

If you are submitting requests for Blue Cross PPO (commercial) members for procedures identified in the list of Services That Require Authorization as requiring authorization as of July 31, 2017, here's what you need to know: This document applies only to Blue Cross Medicare Plus Blue^SM members.

Here's a summary of what's required for both sets of members.

For procedures

• For Blue Cross Medicare Plus Blue members, professional providers must submit authorization requests through the e-referral system for the procedures listed on the Services That Require Authorization document. Authorization criteria related to these procedures are now available on the Blue Cross Authorization Requirements & Criteria page on this website.


• For Blue Cross PPO (commercial) members, professional providers should continue to request authorization only for procedures that currently require it, such as the radiology procedures submitted through AIM and a few others. Joint replacements and similar procedures, which require authorization for Blue Cross Medicare Plus Blue members starting July 31, do not require authorization for Blue Cross commercial members.

For inpatient admissions

Facility providers should submit authorization requests for inpatient admissions through the e-referral system for dates of service on or after July 31, 2017, instead of using the prenotification system that's been used for these requests in the past.

For issues related to Blue Cross commercial member authorizations, please call 1-800-572-3413.

For Issues related to Blue Cross Medicare Plus Blue member authorizations, please call 1-866-309-1719.

To add a temporary member to Blue Cross commercial, such as a newborn admitted to a NICU, please fax requests to 1-866-411-2585.

Posted: July 2017
Line of business: Blue Cross