The services listed below may require precertification for your Blue Cross patients including those with Blue Advantage plans. To see if precertification is needed for a patient, check eligibility and benefits through ProviderAccess.
Precertification requirements are subject to change at any time so it's important to check eligibility requirements for the specific date of service for the procedure or equipment.
Advanced Imaging
Blue Advantage Provider-Administered Drugs
Chiropractic
Durable Medical Equipment (DME)
Genetic Testing
Home Health
Home Infusion
Hospice
Provider-Administered Drugs
Radiation Therapy
Surgical Services
Therapy - Occupational, Physical, Speech
Blue Cross and Blue Shield Plans give providers the ability to access out-of-area member’s Blue Plan provider portals to conduct electronic pre-service review.
Services Requiring Precertification - Out-of-State Providers
Note: These videos contain examples and are intended for demonstration purposes only. Not all services requiring precertification are included. View a list of procedure codes for Surgical Services Requiring Precertification.
To determine whether precertification is needed for a patient, always check eligibility and benefits through ProviderAccess.
Precertification is required for some inpatient surgical procedures that fall outside of the Concurrent Utilization Review Program (CURP) process. The admitting physician is responsible for initiating and obtaining the precertification prior to the patient being admitted to the hospital.
Courtesy predetermination will be provided for the services below when performed in an outpatient setting. Precertification is required if performed in an inpatient setting.