Utilization Management

Prior Authorization and Predetermination 

This page provides a summary of pre-service requirements and recommendations for Blue Cross and Blue Shield of Oklahoma (BCBSOK) members. The following information is for BCBSOK members only.

For more information on additional Blue Cross and Blue Shields members refer to the following links:

Eligibility and Benefits Reminder: An eligibility and benefits inquiry should be completed first to confirm membership, verify coverage and determine whether or not prior authorization (also known as preauthorization, pre-certification or pre-notification) is required.

Clinical Information Notice
Reminder:
 Requests for authorization must in all cases be accompanied by appropriate clinical/medical record information except for routine vaginal or cesarean section deliveries. Please submit clinical/medical record information for routine deliveries only upon request. This will assist in faster, more efficient processing of authorizations for those deliveries and eliminate unnecessary work for you and your organization.

Utilization Management

Utilization management review requirements and recommendations are in place to help ensure our members get the right care, at the right time, in the right setting. Learn about the types of utilization management reviews – prior authorizationpredetermination and post-service review. Learn More

How to Request Prior Authorization or Predetermination

Review the process to submit requests for prior authorizations and predeterminations. Learn More

Prior Authorization and Post-Service Review Lists

Download the lists of services and/or procedure codes that may require prior authorization or post-service reviews. Learn More