Pre-certification / Preauthorization
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.
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 (BCBSKS) and is provided for reference only. This information is NOT to be relied upon as preauthorization or pre-certification for health care services and is NOT a guarantee of payment. To verify coverage or benefits or determine pre-certification or preauthorization requirements for a particular member, call 800-676-BLUE or send an electronic inquiry through your established connection with your local Blue Plan.
Pre-certification / Preauthorization information for out-of-area members
To view the out-of-area Blue Plan's general pre-certification/preauthorization information,enter the first three letters of the member's identification number on the Blue Cross Blue Shield ID card, and click "GO."
If you experience difficulties or need additional information, please contact 800-676-BLUE.
- All in-patient medical stays (requires secure login with Availity)
- All in-patient mental health stays
- All home health and hospice services
- Transplants with the exception of cornea and kidney
Disclaimer: Some employer groups have some specific items that require prior authorization. Call for more information.
Predetermination/Prior authorization required
Please complete and fax the BCBSKS predetermination or prior authroization form embedded within each policy below:
- ACA Prevention Copay Waiver Criteria – Individual Marketplace, Commercial
- BRCA 1 and BRCA 2 Testing
- Compounded Prescriptions
- Denosumab (Prolia and Xgeva)
- Human Growth Hormone
- Intravenous and Subcutaneous Immune Globulin Therapy
- Site of Care Infusion Management
All other drugs may be prior authorized electronically by completing the prior authorization form through CoverMyMeds. If you need medical policies for these drugs, you will find a list below the CoverMyMeds form.
Many of our pharmacy medical policies are now being maintained through our pharmacy benefit manager,
To find pharmacy medical policies specific to a medication list, use the links below.