blue cross blue shield prior authorization list


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  • Why is it so hard to get a prior authorization?

    Insurance companies can deny a request for prior authorization for reasons such as: The doctor or pharmacist didn't complete the necessary steps.
    Filling the wrong paperwork or missing information such as service code or date of birth.

  • What is the prior authorization process?

    Prior authorization—sometimes called preauthorization or precertification—is a health plan cost-control process by which physicians and other health care providers must obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

  • Prior authorization non-urgent review: When you need to get a certain health care service, but it is not urgent.
    It can take up to nine days for us to make our decision.
    This is the most common type of prior authorization request.

  • Does BCBS CA require prior authorization?

    Prior authorization means that your doctor must get approval from Blue Shield before prescribing specific medications or performing a particular medical service or operation.
    Without this prior approval, Blue Shield may not pay for your medication or medical procedure, and you will have to pay out of pocket.

  • The “Prior authorization list” is a list of designated medical and surgical services and select prescription Drugs that require prior authorization under  Autres questions
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