Blue cross blue shield prior authorization list

Need to create a new pre-certification request for your patient or to view the status of an existing pre-certification request?
Visit the secure pre-certification section.

Sign-in to Availity

Members of some group health plans may have terms of coverage or benefits that differ from the information presented here.  The following information describes the general policies of Blue Cross and Blue Shield of Kansas (BCBSKS) and is provided for reference only.  This information is NOT to be relied upon as prior-authorization or precertification for health care services and is NOT a guarantee of payment.  To verify coverage or benefits or determine pre-certification or preauthorization requirements for a particular member, call 800-676-BLUE or send an electronic inquiry through your established connection with your local Blue Plan.

Pre-certification / Preauthorization information for out-of-area members

To view the out-of-area Blue Plan's general pre-certification/preauthorization information, enter the first three letters of the member's identification number on the Blue Cross Blue Shield ID card, and click "GO."

Alpha prefix:

If you experience difficulties or need additional information, please contact 800-676-BLUE.

Pre-certification required

• All in-patient medical stays (requires secure login with Availity) 800-782-4437
• All in-patient mental health stays 800-952-5906
• All home health and hospice services 800-782-4437
• Transplants with the exception of cornea and kidney 800-432-0272

Disclaimer: Some employer groups have some specific items that require prior authorization. Call for more information.

Predetermination/Prior-authorization required

Please complete and fax the BCBSKS predetermination or prior authorization form embedded within each policy below:

• ACA Prevention Copay Waiver Criteria – Individual Marketplace, Commercial
• Compounded Prescriptions
• Germline Genetic Testing for BRCA1 or BRCA2 for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers
• Human Growth Hormone
• Immunoglobulin Therapy
• Site of Care Infusion Management
• Zolgensma

All other drugs may be prior authorized electronically by completing the prior authorization form through CoverMyMeds. If you need medical policies for these drugs, you will find a list below the CoverMyMeds form.

Many of our pharmacy medical policies are now being maintained through our pharmacy benefit manager, Prime Therapeutics.

To find pharmacy medical policies specific to a medication list, use the links below.

• BCBSKS BlueCare/EPO Prior Authorization (offsite link)
• BCBSKS ResultsRx Prior Authorization (offsite link)
• BCBSKS Select Prior Authorization (offsite link)

Policies may be temporarily housed here prior to being posted to the myprime.com website.

• GLP-1 (glucagon-like peptide-1) Agonists Prior Authorization with Quantity Limit

ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call 1-800-200-4255 (TTY: 711).

ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-200-4255 (TTY: 711 ).

ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID chamar  1-800-200-4255 (TTY: 711 ).

ATTENTION : si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Appelez le Service adhérents au numéro indiqué sur votre carte d’assuré appel 1-800-200-4255  (TTY : 711 ).

注意：如果您讲中文，我们可向您免费提供语言协助服务。请拨打您 ID  卡上的号码联系会员服务部 通话 1-800-200-4255（TTY  号码：711 )。

ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-200-4255 TTY: 711 ).

LƯU .: Nếu quý vị n.i Tiếng Việt, c.c dịch vụ hỗ trợ ng.n ngữ được cung cấp cho quý vị miễn ph.. Gọi cho Dịch vụ Hội vi.n theo số tr.n thẻ ID của quý vị Cuộc gọi 1-800-200-4255 (TTY: 711 ).

ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов  1-800-200-4255 (телетайп: 711 ).

ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ  វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្  រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ  វាសមា  ជិកតាមល េខន  ៅល.  ើប ័ណ្ណ សម្  គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ  1-800-200-4255 (TTY: 711) ។

ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata  1-800-200-4255 (TTY: 711 ).

참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-200-4255 (TTY : 711)로 회원 서비스에 연락하십시오.

ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας υπηρεσίες γλωσσικής βοήθειας, δωρεάν. Καλέστε την Υπηρεσία Εξυπηρέτησης Μελών στον αριθμό της κάρτας μέλους σας (ID Card) κλήση 1-800-200-4255 (TTY: 711 ).

UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej. Należy zadzwonić do Działu obsługi ubezpieczonych pod numer podany na identyfikatorze zadzwoń 1-800-200-4255 (TTY: 711 ).

ध्यान दें: य दि  आप ह िन् दी बोलते ह ैं, तो भा षा  सहाय  ता  सेवा एँ, आप के लि ए नि :शुल्क  उपलब्ध ह ैं। सदस्य  सेवा ओं को आपके आई.डी. कार  ्ड पर दि ए गए नंबर पर कॉल करें  कॉल 1-800-200-4255 ( टी .टी .वा ई.: 711).

ધ્યાન આપો:  જો તમે ગુજરા તી બોલતા  હો, તો તમને ભા ષા કીય  સહાય  તા  સેવા ઓ વિ ના  મૂલ્યે  ઉપલબ્ધ છે. તમા રા  આઈડી કાર  ્ડ પર આપેલા  નંબર પર Member Service  ને કૉલ કરો કૉલ કરો 1-800-200-4255 (TTY: 711).

PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-200-4255 (TTY: 711 ).

お知らせ：日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください 呼び出す 1-800-200-4255（TTY: 711 ）。

ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-200-4255 (TTY: 711 ).

ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-200-4255 (TTY: 711).

BAA !KOHWIINDZIN DOO&G&: Din4 k’ehj7 y1n7[t’i’go saad bee y1t’i’ 47 t’11j77k’e bee n7k1’a’doowo[go 47 n1’ahoot’i’. D77 bee an7tah7g7 ninaaltsoos bine’d44’ n0omba bik1’7g7ij8’ b44sh bee hod77lnih call 1-800-200-4255 (TTY: 711).

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