Inpatient Elective/Prospective Admissions, Outpatient Procedures on Prior Authorization List (Home Care, Physical, Occupational & Speech Therapy must use Clear Coverage)

Online with Clear Coverage 
call 1-800-363-4658, or fax to 1-800-222-8182

Elective Procedures & Outpatient Services ManualOpen a PDF
Elective Procedures & Outpatient Services Tip SheetsOpen a PDF

Urgent/Emergent Medical Admissions (Facility)

Online with Clear Coverage
call 1-800-363-4658, or fax to 1-800-292-5109

Acute Medical-Surgical Inpatient ManualOpen a PDF
Acute Medical-Surgical Inpatient Tip SheetsOpen a PDF

Other Emergency Admissions, Elective Admissions or Surgical/Medical Authorizations

Request to Customer Care: call 1-800-363-4658

Implantable Cardiac Devices, Radiology/Imaging, Radiation Therapy or Musculoskeletal Services (large joint replacement, pain management and spine services)

Online with eviCore healthcare
or call 1-866-889-8056

Behavioral Health

For Commercial & Medicare: Call 1-800-363-4658
Once the preauthorization has been obtained, call Behavioral Health Utilization for the clinical review: 1-800-277- 2138.

For Medicaid & Child Health Plus: 
Call 1-844-694-6411 or fax 1-844-878-6989.

Behavioral Health Fax and Request Forms Opens a dialog

Medical Intake

Call: 1-844-694-6411 or Fax: 1-844-279-7140
Concurrent review can be faxed to: 1-855-742-0126

SafetyNet Fax Form for Inpatient Preauthorization RequestsOpen a PDF (Use Inpatient form for Observation Level of Service)
SafetyNet Fax Form for Outpatient Preauthorization RequestsOpen a PDF

Medical Specialty Drug

• Medical Specialty Drug (For Commercial, Essential Plan, Exchange and Medicare)Open a PDF
• Medical Specialty Drug (for Medicaid and Child Health Plus)Open a PDF

For Commerical, Exchange & Medicare:
Online with Clear Coverage
For Medical Specialty Drug Unit, call: 1-800-306-0151, or fax: 1-800-306-0188.
Drug Prior Authorization Fax forms.

For Medicaid & Child Health Plus:
Call: 1-844-694-6411, or Fax: 1-855-346-4418

SafetyNet Fax Form for Inpatient Preauthorization RequestOpen a PDF
SafetyNet Fax Form for Outpatient Preauthorization RequestOpen a PDF

Other Prescription Drugs

Online through CoverMyMeds ePA Portal
Fax: Prior Authorization Fax Request Forms
Eform: Send Request via Secure Eform (sends to our FAX server)

Urgent Requests After-Hours (weekdays after 5 p.m. and weekends EST)

Call 1-877-303-8887 (nurses will collect information to be entered into our systems the next business day)

Members of Other Blue Plans (Pre-Service Review)

Pre-Service Review Online, or call the number on the Member's ID Card