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Your Guide to Understanding Prior Authorization

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What is prior authorization?

Prior authorization is a process that helps make sure health care is appropriate, effective and covered — before it happens.  

You’ll sometimes hear prior authorization called preauthorization, pre-certification or prior approval. 

Why do we do prior authorization?

  • We check that the service or drug asked for is covered by your plan for your health issue or condition.
  • We make sure it is considered appropriate and necessary based on proven clinical guidelines
  • We focus prior authorization reviews where they matter most, so you get the care you need.
  • We protect our member's safety and financial security by making sure the most high-cost and high-risk procedures are reviewed before care is delivered. 
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How do I know if I need prior authorization?

Most plans need prior authorization before you have certain services like surgeries, advanced imaging, specialty medications and some behavioral health treatments.*

Here's how to find out:

  • Check your plan details – Requirements vary by plan, so review your benefits or member materials.
  • Search for your service or drug – Use our online tools to look up medical procedures, prescription drugs or behavioral health services that may require prior authorization.
  • Ask your doctor – In most cases, your doctor will know if prior authorization is needed and will submit the request for you.
  • Call customer service – If you’re unsure, call the number on your BCBSXX member ID card for help.

Search Services That Need Prior Authorization

If you're fully insured, or have an employer-sponsored plan or individual and family plan, look up procedures, prescription medicines and behavioral health service that might require prior authorization.

Not fully insured? Review your Summary of Benefits and Coverage (SBC) in your online member account. Medicaid members should visit our Medicaid website to review prior authorization details.

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Medical Procedures

Some medical procedures like surgeries, organ transplants, imaging or therapies often require a prior authorization request.

Search medical procedures
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Medical or Prescription Drugs

Search medical drugs, like specialty prescriptions or those with specific use guidelines, that may require prior authorization.

Search medical drugs
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Behavioral Health Services

Prior authorization may be required for some behavioral services like psychological testing or psychiatric care.

Search behavioral health care
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What to Expect: A Step-By-Step Guide

What does the prior authorization process look like? Here's a short guide to help you know what to expect:

  1. You and your doctor decide on the care you need. They'll normally tell you if your services or medicine need prior authorization.
  2. Your provider will normally start the prior authorization process by submitting documents to BCBSIL.
  3. Prior authorization is submitted to BCBSIL and reviewed.
  4. A decision is made and shared with you and your provider. If your request is denied, you or your doctor can file an appeal.

 

How can I check my prior authorization status?

To check the status of your prior authorization request, log in to your online member account. There, you'll see your prior authorization request history and the statuses.

Log In to Start

Review BCBSIL's Prior Authorization Code Lists

Not sure if a service or medication needs prior authorization? Down load the full lists below to check.

(Requirements are current as of January 1, 2026, unless noted otherwise.)

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Making Requests Simple

Most of the time, your doctor will take care of prior authorization for you. They’ll most likely submit a request and get approval before they offer your care. But it’s always a good idea to check, especially if your doctor's not in your plan network. If you use an out-of-network doctor, you may need to handle prior authorization. Start by calling the number on your member ID card.  

When you call, we'll need the following information:

  • Your name, subscriber ID number and date of birth
  • Your provider’s name, address and National Provider Identifier (NPI)
  • Information about your medical or behavioral health condition
  • Your provider's proposed treatment plan, including any diagnostic or procedure codes
  • When you'll get care and, if you're being admitted, an estimated length of stay
  • Where you’re being treated

Frequently Asked Questions

Common Questions About the Prior Authorization Process

 

Resources

Helpful Articles for Prior Authorization

*Prior authorization is not a guarantee of benefits or payment. The terms of a member’s plan control the available benefits.