Feb. 25, 2026
Prior authorization is required for most services rendered by out-of-network providers for our members with Blue Cross Community Health PlansSM. Services performed without required prior authorization or that don’t meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
Exclusions from this requirement for BCCHPSM include emergency services; family planning; screening services provided under the Early and Periodic Screening, Diagnostic, and Treatment benefit for children; and other services.
For more information, refer to our Medicaid service authorization requirements summary.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.