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Medical Review

Precertification / Pre-authorization

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BlueAccess®

Need to create a new pre-certification request for your patient or to view the status of an existing pre-certification request?
Visit the secure pre-certification section in BlueAccess.

Members of some group health plans may have terms of coverage or benefits that differ from the information presented here.  The following information describes the general policies of Blue Cross and Blue Shield of Kansas and is provided for reference only.  This information is NOT to be relied upon as pre-authorization or pre-certification for health care services and is NOT a guarantee of payment.  To verify coverage or benefits or determine pre-certification or pre-authorization requirements for a particular member, call 800-676-BLUE or send an electronic inquiry through your established connection with your local Blue Plan.


Precertification/Pre-authorization Information for Out-of-Area Members

To view the out-of-area Blue Plan's general precertification/pre-authorization information,enter the first three letters of the member's identification number on the Blue Cross Blue Shield ID card, and click "GO."

Type of information being requested

Please select one at a time

If you experience difficulties or need additional information, please contact 800-676-BLUE.


Precertification required Contact
All in-patient medical stays (requires secure login with Availity) 800-782-4437
All in-patient mental health stays 800-952-5906
All home health and hospice services 800-782-4437
Transplants with the exception of cornea and kidney 800-432-0272
Pre-determination/prior-authorization required
Afrezza (human insulin)
Ampyra™ (dalfampridine)
Androgens and Anabolic Steroids
Antidepressant Agents
Antihypertensive Medications
Benlysta® (belimumab) Prior Authorization
Biologic Immunomodulators Therapy
BRCA 1 and BRCA 2 Testing
Denosumab (Prolia and Xgeva)
Glucose Test Strips/Disks
Hepatitis B / Oncology and Hepatitis C First Generation Agents (Pegasys®/Pegasys, Proclick®/peginterferon alfa-2a, PegIntron®/peginterferon alfa-2b and Olysio™/ simeprevir)
Hepatitis C Second Generation Antivirals – Through Preferred Oral Agent(s) (2015) (Harvoni® [ledipasvir / sofosbuvir] and Viekira Pak [ombitasvir/ paritaprevir/ritonavir + dasabuvir)
Hepatitis C - Sovaldi® [sofosbuvir] (2015) - Through Preferred Agent(s)
Hereditary Angioedema (Berinert, Cinryze, Firazyr, Kalbitor, Ruconest)
H.P. Acthar Gel (repository corticotropin)
Human Growth Hormone
Idiopathic Pulmonary Fibrosis (Esbriet®/pirfenidone, Ofev®/nintedanib)
Intravenous and Subcutaneous Immune Globulin Therapy
Kalydeco™ (ivacaftor)
Multiple Sclerosis Agents
Oral Immunotherapy Agents (Grastek®, Oralair®, Ragwitek™)
Oxycodone Extended Release (ER)
Self Administered Oncology Drugs
Statin Therapy
Synagis
Tysabri® (natalizumab) and Lemtrada™ (alemtuzumab) (IV Multiple Sclerosis Agents)
Xolair® (omalizumab)
Xyrem® (sodium oxybate)

Disclaimer: Some employer groups have some specific items that require prior authorization. Call for more information.