Precertification Requirements and Forms

PW_A085072
 
Important Changes to Medical Referral Request and Referral and Pre-Authorization Inquiry on ProviderAccess

Effective December 12, 2014, you will only be able to access Medical Referral Request and Referral and Pre-Authorization Inquiry using the Interactive Care Reviewer (ICR) on the Availity Web Site. These functionalities will no longer be available on ProviderAccess. Please begin using the ICR now! Registered Availity users can go to Availity.com and click “Auths and Referrals” located on the left navigation menu. If you do not see “Auths and Referrals”, contact your Availity Primary Access Administrator (PAA). If your organization is not registered for Availity, go to availity.com and click “Get Started”. 
 
Standard Precertification Requirements  
SHBP Precertification Requirements List - effective 1/1/2014
Sleep Management Precertification CPT Codes
Radiation Therapy Precertification CPT Codes
Precertification Requirements List - effective 8/1/2014
Medicare Advantage Precertification Requirements List
Precertification Procedure Codes Sheet – effective 8/1/2014
Outpatient Diagnostic Imaging Precertification Procedure Codes Sheet - effective 01/01/2013
 
Precertification Forms  
Cancer Care Quality Program FAQ's
Continuation of Care Coverage Request Form
Interactive Care Reviewer FAQs
Interactive Care Reviewer (ICR) Brochure
Medicare Advantage General Precert Form
MPI – Stress Echo Clinical Worksheet
Precertification Form for Procedures and Diagnostics
Pre-Existing condition review for Radiology and Pre-Service Reviews
Primary Care Physicians Referral Form
Request for Transition of Out of Network Care (TOC) – HMO/POS members
Request for Transition of Out of Network Care (TOC) – PPO/ASO Group members
 
Medical-Surgical Clinical Data Submissions Tools  
Medical-Surgical Clinical Data Submissions Tools
 

Footer Links:

© 2014 BlueCross BlueShield of Georgia
Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.