Pre-Service Review (Precertification/Predetermination)

Online Precertification

Online precertification or pre-service review is available for the services listed below. Go to your local Blue Plan's provider portal to initiate pre-service review 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.

Precertification requirements are subject to change at any time so it's important to check patient eligibility and benefits for the specific date of service for the service or equipment you will be providing.
 

  • Advanced Imaging
  • Behavioral Health
  • Cancer Treatment Pathways (Medical Oncology)
  • Durable Medical Equipment - Motorized/Power Wheelchairs
  • Genetic Testing
  • Physician-Administered Drugs
  • Radiation Therapy
  • Surgical Services:
    • Breast reconstruction
    • Blepharoplasty, brow lift or ptosis repair
    • Gastric restrictive procedures (if covered by the group plan)
    • Implantable bone conduction hearing aids
    • Knee arthroplasty
    • Lumbar spinal fusion
    • Reduction mammoplasty
    • Rhinoplasty
    • Surgery for obstructive sleep apnea
    • Surgery for varicose veins
    • Wireless capsule endoscopy

Precertification via Fax/Phone/Mail

Use the forms at the bottom of this page to request precertification for the services listed or call the appropriate toll-free number to initiate precertification for these services via telephone:

  • 1-844-594-6010 – Chiropractic and Physical/Occupational/Speech Therapy 
  • 1-855-288-8357 – Other services, including peer-to-peer consultations:
    • Home Health
    • Hospice
    • Inpatient Hospital
    • Long-Term Acute Care