You and your provider can still decide to get the services, but you may have to pay for them. Because you are still responsible for ensuring that your care is precertified, you should always ask your provider if they have contacted us and provided all the necessary information. Print Utilization Management. In most cases, your physician or facility will take care of requesting precertification. Please review the terms of use and privacy policies of the new site you will be visiting. In general, your network PCP and other network providers are responsible for obtaining prior authorization before they provide these services to you. Por obtenir des services … Para servicios gratuitos de asistencia con el idioma, llame al (800) 247-2583. Prior approval for requested services. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services. We provide health insurance in … Learn more here. Authorization requirements may vary based on the member’s benefit plan. For some services listed in our medical policies, we require prior authorization. Federal Employee Program, Blue Cross and Blue Shield's Federal Employee Program, Inpatient residential treatment center admission. This is called a prior authorization. In some situations, you need to get your care, treatment or prescription drugs approved before we cover them. When you request prior authorization from us, we want the process to be fast, easy and accurate. We use cookies on this website to give you the best experience and measure website usage. Out-of-area providers You will need your ID card to sign up. You can see the status of your referrals and prior authorizations by logging in to your Blue Access for MembersSM account. .new-material-banner p:before { The protection of your privacy will be governed by the privacy policy of that site. These medical services may require prior approval: Inpatient hospital admission; Inpatient residential treatment center admission; Skilled nursing facility admission; Other services, including but not limited to: Radiology (MRI, CT scans, PET scans) Hospice care Inpatient admissions, services and procedures received on an outpatient basis, such as in a doctor's office, -->. Because we’re in this together. The RQI requirement applies when non-emergency high-tech imaging services are performed in a physician's office, the outpatient department of a hospital, or a freestanding imaging center. Monday – Friday 8 a.m. – 5 p.m. CT,