Utilization Management Forms

Below are links to various utilization-management-related forms, some of which are used to request authorization for various services. These forms are also available, along with others, on BCN's Forms page within Provider Secured Services. To access the complete Forms Library, log in to Provider Secured Services, click BCN Provider Publications and Resources and then click Forms.

BCN AdvantageSM

Skilled nursing facilities and home health agencies

Hospitals, for patients in observation

Hospitals, for inpatients

Noncontracted providers

Member form

Behavioral health services

Drugs covered under the medical benefit

For information about drugs covered under the medical benefit, visit the Medical Benefit Drugs – Pharmacy page on this website.


Sign up or change a user

Transitional care services

Note: For BCN Advantage members admitted to post-acute care on or after June 1, 2019, see Post-acute care services: Frequently asked questions by providers (PDF).