Prior Authorization

Always check benefits through the voice response unit or My Insurance Manager^SM to determine if prior authorization is required.

Healthy Blue requires prior authorization for certain procedures and durable medical equipment. This process allows us to check ahead of time whether services meet criteria for coverage by a member’s health plan.

To search for authorization by code, use the Prior Authorization Lookup Tool below.

In many cases, approval is instant. When it’s not, we’ll review your request, considering:

• Our medical policies.
• Recognized clinical guidelines.
• The terms of the member’s benefit plan.

Some requests may require additional documentation.

How to Request Prior Authorization

Medical Services

When you request prior authorization from us, we want the process to be fast, easy and accurate. We offer these convenient options:

• Call Provider Service at 866-757-8286.
• Medical Forms Resource Center (MFRC) — This online tool makes it easy to submit prior authorization requests for certain services. The tool guides you through all the forms you need so you can avoid follow-up calls for additional information.
• My Insurance Manager — You also can submit prior authorization using the same online self-service provider tool you can use to check eligibility, manage claims and more. Refer to the available guide for assistance.

Behavioral Health Services

• Call 800-868-1032.
• Fax 803-870-6506. 
• Forms Resource Center — This online tool makes it easy for behavioral health clinicians to submit behavioral health prior authorization requests. The tool guides you through all the forms you need so you can avoid follow-up calls for additional information.
• My Insurance Manager — You also can submit prior authorization using the same online self-service provider tool you can use to check eligibility, manage claims and more. Refer to the available guide for assistance.