PA Resources Portlet

Resources

CODING & DOCUMENTATION

EDUCATION & EVENTS

ENROLLMENT & CREDENTIALING

FORMS & MANUALS

PATIENT HEALTH

PHARMACY

POLICIES & GUIDELINES

PRE-SERVICE REVIEW

PROGRAMS & INITIATIVES

PROVIDER eSOLUTIONS

PROVIDER NETWORKS & SPECIALTIES

PA Dynamic Rendering

PRE-SERVICE REVIEW

Pre-Service Review

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 Part B 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

Online Tutorials

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
 

Services Requiring Precertification
January 2021


Services Requiring Precertification - Out-of-State Providers
January 2021

Change Healthcare InterQual Criteria