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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

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Precertification Requirements and Forms

PW_A085072
 
Interactive Care Reviewer (ICR) precertification tool  
Request outpatient procedures for many members covered by BCBSGa plans via Availity at availity.com
ICR Training
Immediate authorization decision via ICR
 
Precertification Requirements  
Ancillary Precertification Requirements: Ground Ambulance/Transportation, Non-emergent
Diagnostic Imaging and Cardiology Program CPT code list
Genetic Testing Precertification required - performed by AIM
Medicare Advantage Precertification Requirements List
Radiation Therapy Precertification CPT Codes
SHBP Precertification Procedure Codes Sheet - effective 8/1/2017
SHBP Precertification Requirements List - effective 1/1/2017
Sleep Management Precertification CPT Codes
Standard Precertification Requirements List – effective 7/1/2017
Standard Precertification Procedure Codes Sheet – effective 7/1/2017
 
Precertification Forms  
Cancer Care Quality Program FAQ's
Continuation of Care Coverage Request Form
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
 
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