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Utilization Management


Utilization Management Request Tool

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

Prior Authorization Procedure Search Tool

Use our Prior Authorization Procedure Search Tool, available 24/7, to determine if you need to get prior authorization (PA) before providing services to your patients enrolled in our fully insured commercial plans, Horizon Medicare Advantage plans, Braven Health℠ plans and the State Health Benefit Program (SHBP) and School Employees' Health Benefit Program (SEHBP).

If you have questions about other self-insured members, please call the Provider Services number listed on the back of the member's card.

We collaborate with certain business partners to manage PA reviews on our behalf. The tool will let you know when requests need to be submitted directly to these business partners.

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.

UNITE HERE HEALTH

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