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Prior Authorization & Claims

Find information about Healthy Blue services requiring prior authorization (PA), as well as important details about our claims process.

Access Availity

Find important self-service tools to review ongoing claims, or check the eligibility of members under your care.

Services Requiring Prior Authorization (June 2015)

Services requiring prior authorization (PA) for Healthy Blue members enrolled in the Healthy Connections program can be found by viewing the PA grid on our website. This list may not be all-inclusive; the last date this list was updated can be found at the top of the grid.

Providers are responsible for verifying eligibility and benefits before providing services to Healthy Blue members. Except for an emergency, failure to obtain PA for the services listed may result in a denial for reimbursement.

Providers can access our Medical Policies and UM Guidelines and/or our Clinical Practice Guidelines for specific information about our policies.

Note: Referral to an out-of-network provider and/or facility requires prior authorization for all services.

Requesting Prior Authorization

To request PA, report a medical admission or ask questions regarding PA, please contact our Utilization Management department at:

Phone: 1-866-902-1689
Fax: 1-800-823-5520 

Prior Authorization Forms

General Prior Authorization Forms

Forms for Specific Procedures/Items

Please contact the Utilization Management Intake department for any questions on prior authorization at 1-866-902-1689 or fax 1-800-823-5520.

* These links lead to a third-party site. That organization is solely responsible for the contents and privacy policies on its site.

Claims

Need information about our claims process? You'll find it here!