Services Requiring Prior Authorization (June 2015)
Services requiring prior authorization (PA) for BlueChoice HealthPlan Medicaid 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 BlueChoice HealthPlan Medicaid members. Except for an emergency, failure to obtain PA for the services listed may result in a denial for reimbursement.
Providers can access our Clinical Utilization Management 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:
General Prior Authorization Forms
Forms for Specific Procedures/Items
Please contact the UM intake department for any questions on prior authorization at 866-902-1689 or fax 800-823-5520.
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