What is prior authorization?

How the prior authorization process works and when it is required

Prior authorization – often called a PA – is a process Blue Cross of Idaho and other health insurance carriers use to help members get the right care, in the right setting, at the right time. We do this by making sure certain non-emergency services and procedures are medically necessary before they are done.

Using PA to make sure the services our members get are appropriate helps us manage medical costs for our members.

This isn’t just a way to tell you, “no.” Instead, it’s a safeguard against our members getting unnecessary services – like surgeries, medical equipment or tests – that are invasive, not needed and may leave them with high out-of-pocket costs when an alternative treatment might be a better option.

How Does It Work?

Typically, your provider will need to contact us when ordering a procedure or service that requires a PA. After getting the PA request, we will contact your provider to share if we approve or deny the request. In some cases, we may ask for more information.

What Services Need PA?

Not all procedures or services need PA. You can find a list of services that require PA by:

• Viewing the PA list for your plan online. Visit bcidaho.com, log in to your member account, select Resources & Forms, then Medical Prior Authorization List.
• Reading your member contract. Find a copy by visiting bcidaho.com, logging in to your account, selecting My Account, then My Contract.
• Calling customer service at the number on the back of your member ID card.

Emergency procedures and services do not need a PA from Blue Cross of Idaho.

Posted: September 8, 2021