Pre-Service Review (Precertification/Predetermination)

Online Precertification

Precertification may be required for the services listed below. Go to your local Blue Plan's provider portal to see if precertification is required for these services for out-of-area members. Contact your local Blue Plan for more information on how to access this functionality in your local provider portal.

It's important to always check patient eligibility and benefits through your local Blue Plan provider portal or your practice management system. Precertification requirements are subject to change at any time so you should verify benefits for the specific date of service for the service or equipment you will be providing.

• Advanced Imaging
• Behavioral Health
• Durable Medical Equipment (DME)
• Genetic Testing
• Provider-Administered Drugs
• Radiation Therapy Management
• Some Surgical Services 

Precertification via Fax/Phone/Mail

Precertification is required for the following services and must be requested by fax, phone or mail:

• Home Health
• Hospice
• Inpatient Hospital
• Long Term Acute Care

Use the forms below to request precertification for these services or call the appropriate toll-free number:
 

• Call 1-844-594-6010 - Chiropractic and Physical/Occupational/Speech Therapy 
• Call 1-855-288-8357 - Other services, including peer-to-peer consultations

Predetermination

Courtesy predetermination will be provided for the services below when performed in an outpatient setting. Precertification is required if performed in an inpatient setting. 

Predetermination Review