You can call your insurance company about a prior authorization, and it's usually a good idea to do so if you're unsure about the status of your request.
Insurance companies typically have a dedicated phone number for prior authorization requests, and you can find this number on your insurance card or by visiting their website.
Be prepared to provide your policy number, the name of your doctor, and the specific medication or treatment you're requesting.
It's also a good idea to ask about any additional information you may need to provide to speed up the process.
Who to Contact
You can submit a prior authorization request on your own by finding the appropriate prescription drug or medical procedure authorization form for your situation, or by logging into your account on the website and completing the request online.
If you need help finding the right form, you can call (800) 535-9481.
Your healthcare provider, authorized representative, or you may also submit a prior authorization request by calling (800) 535-9481.
If you have any questions, you can call the Customer Service number on your Blue Shield member ID card.
You can also reach out to Blue Shield of California directly for any questions or concerns you may have.
Expand your knowledge: Check Prior Authorization Status Blue Cross Blue Shield
Prior Authorization Process
You can submit a prior authorization, advance notification, or admission notification through several channels. You can use the UnitedHealthcare Provider Portal to submit your requests in real time.
There are digital options available to streamline the process. The Provider Portal is a convenient way to submit your requests, and it's available 24/7.
You can also use Electronic Data Interchange (EDI) to automate prior authorization and notification tasks. EDI is a digital solution that can save you time and effort.
If you're unable to use the Provider Portal, you can call the Provider Services number at 877-842-3210 to submit a request. This option is available for all commercial plans.
You can also submit requests by fax, but this option is only available for specific commercial plans in Massachusetts, Nevada, New Mexico, and Texas. The fax number is 855-352-1206.
Here are the options for submitting prior authorizations, advance notifications, and admission notifications:
Evernorth
Evernorth offers a convenient way to manage medical and pharmacy drug prior authorization through EviCore by Evernorth.
For Cigna Healthcare patients, you can choose between Medical Oncology Pathways for oncology pharmacy drug and medical prior authorization, or Pharmacy Drugs (Express Scripts Coverage) for other pharmacy drug prior authorization.
You can learn more about EviCore by Evernorth to understand its features and benefits.
If you're looking for more information on managing prescriptions, you can also learn more about Surescripts.
For another approach, see: Bcbs Pharmacy Prior Authorization
Frequently Asked Questions
How can I speed up my prior authorization?
To speed up the prior authorization process, stay informed about changing industry standards and designate a single staff member to handle prior authorization responsibilities. By doing so, you can streamline procedures and reduce delays.
Why is my prior authorization taking so long?
Prior authorization delays are often caused by the manual process and frequent changes to forms and details, which can take time to navigate. Learn how to streamline your prior authorization process and reduce delays.
Who is responsible for obtaining preauthorization?
Your in-network healthcare provider starts the prior authorization process, but if you're out-of-network, you're responsible for obtaining preauthorization
Why would insurance deny a prior authorization?
Insurance may deny prior authorization if a less expensive alternative is available and deemed equally safe and effective. This is often done to encourage cost-effective treatment options and minimize healthcare expenses.
Sources
- https://www.blueshieldca.com/en/home/be-well/pharmacy/drug-prior-authorizations
- https://www.bcbsks.com/providers/precertification-prior-authorization
- https://nhhealthcost.nh.gov/guide/question/do-i-need-permission-or-authorization-my-insurance-company-i-get-medical-care
- https://www.cigna.com/health-care-providers/coverage-and-claims/prior-authorization
- https://www.uhcprovider.com/en/prior-auth-advance-notification.html
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