Precertification and Prior-Authorization
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 prior-authorization or precertification 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) 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
Disclaimer: Some employer groups have some specific items that require prior authorization. Call for more information.
Please complete and fax the BCBSKS predetermination or prior authorization form embedded within each policy below:
- ACA Prevention Copay Waiver Criteria – Individual Marketplace, Commercial
- Compounded Prescriptions
- Continuous Glucose Monitoring
- Germline Genetic Testing for Hereditary Breast/Ovarian Cancer Syndrome and Other High-Risk Cancers (BRCA1, BRCA2, PALB2)
- Hemophilia B Gene Therapy Medical Drug Criteria Program Summary
- Human Growth Hormone
- Immunoglobulin Therapy
- Off-Label, Approved Orphan, and Expanded Access (Compassionate Use) Drugs
- Site of Care Infusion Management
- Skysona (elivaldogene autotemcel)
- Vyjuvek (beremagene geperpavec- svdt) Medical Drug Criteria Program Summary
- Zolgensma Medical Drug Criteria
- Zynteglo (betibeglogene autotemcel)
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, Prime Therapeutics.
To find pharmacy medical policies specific to a medication list, use the links below.
- BCBSKS BlueCare/EPO Prior Authorization (offsite link)
- BCBSKS ResultsRx Prior Authorization (offsite link)
- BCBSKS Select Prior Authorization (offsite link)
Policies may be temporarily housed here prior to being posted to the myprime.com website.