Utilization Management

Utilization Management Request Tool

Submit authorization and referral requests, and check the status of those requests online through NaviNet.

Prior Authorization Procedure Search Tool

Available 24/7, you can use our search tool to find out if you need prior authorization before providing services to your fully insured, State Health Benefit Program (SHBP) and School Employees’ Health Benefit Program (SEHBP) patients. If you have questions about self-insured members, please call the Provider Services number listed on the back of the member’s card.

BlueCard Members

Find out if you need prior authorization for patients enrolled in other Blue Cross Blue Shield plans.

FEP Members

Learn how we manage Prior Authorization & Medical Necessity Determination requests for certain orthopedic and cardiac services for our FEP members.

Medicare Advantage

View a list of services that require prior authorization for our Medicare Advantage members.

UNITE HERE HEALTH

Find out which services require prior authorization for UNITE HERE HEALTH employer groups.