Prior Authorization

Overview

For some services listed in our medical policies, we require prior authorization. When prior authorization is required, you can contact us to make this request.

• Outpatient Prior Authorization CPT Code List (072)
• Prior Authorization Quick Tips
• Forms Library

Non-covered services

• Medical Technology Assessment Non-Covered Services List (400)

Carelon

Carelon, an independent company, conducts utilization management as the delegated vendor for Advanced Imaging/Radiology, Sleep Disorder Management and Genetic Testing.

STANDARD CONTROL WITH ADVANCED CONTROL SPECIALTY FORMULARY

CVS Caremark^®´, an independent company, develops clinical criteria to determine medical necessity for medications, treatments, or supplies for Blue Cross Blue Shield of Massachusetts members who have a health plan that uses the Standard Control with Advanced Control Specialty Formulary.

• Clinical Criteria Standard Control with Advanced Control Specialty Formulary