Authorization Requirements & Criteria

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Below are links to documents detailing Blue Care Network's authorization and referral requirements for services managed by BCN, including lists of procedures that require authorization and authorization criteria and preview questionnaires for various procedures. These apply to services other than drugs covered under the medical benefit. In addition, there are links to information about the Pediatric Choice and Woman's Choice programs.

For drugs covered under the medical benefit, visit the Medical Benefit Drugs page in the BCN section of this website.

For Blue Cross Complete utilization management information, go to

Referral and authorization information

Authorization criteria and preview questionnaires

We use our authorization criteria or our medical policies to make determinations on prior authorization requests for select services. To determine which services have authorization criteria and view authorization criteria and preview questionnaires, see the Authorization criteria and preview questionnaires (PDF).

Pediatric Choice

Woman's Choice

The Woman's Choice program allows BCN members to directly access affiliated physicians who perform obstetric or gynecologic services. In line with Woman's Choice guidelines, an obstetrician-gynecologist may perform or order some services without a referral from the primary care physician.

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