Resources

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

Provider-Administered Oncology Drugs

Radiation Therapy

Surgical Services

Therapy - Occupational, Physical, Speech

Services Requiring Precertification

Pre-Service Review for Out-of-Area Members

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. 

Inpatient Hospital

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.

Predeterminations

Courtesy predetermination will be provided for the services below when performed in an outpatient setting. Precertification is required if performed in an inpatient setting.