Authorizations

There are services and procedures that must be authorized prior to being performed. Authorization requirements may vary based on the member’s benefit plan. To determine if an authorization is required, please always verify each member’s eligibility, benefits and limitations prior to providing services. To do this, use iLinkBlue.

The authorization process ensures that members receive the highest level of benefits to which they are entitled and that the most appropriate setting and level of care for a given medical condition are provided. Our nurses review all pertinent information submitted by physicians and providers and applies defined criteria to determine if a service is medically appropriate. Information received that varies from our defined criteria is reviewed by a Blue Cross physician.

If a hospital fails to obtain proper authorization, all corresponding services, including the physician services, could be subject to penalty for failure to authorize. Please work with the servicing hospital to ensure the proper authorizations are in place prior to the service to avoid penalties.

General authorization requirements are available in our provider manuals and network speed guides, which can be found on the Resources page.

Online Authorization Applications

We offer several online authorization applications that are available 24/7 through iLinkBlue. Each requires user-level security access that is assigned by your organization's administrative representative.