This page provides a summary of preservice requirements and recommendations for Blue Cross and Blue Shield of Oklahoma members. For our Medicare Advantage members, refer to Blue Cross Medicare AdvantageSM.
For members of other Blue Cross and Blue Shield Plans, refer to Medical Policy and Prior Authorization Information for Out-of-Area Members. For the Blue Cross and Blue Shield Federal Employee Program®, refer to
Medical Policies and Utilization Management Guidelines.
Check eligibility and benefits first: Complete an eligibility and benefits inquiry first to confirm membership, verify coverage and determine if prior authorization (also known as preauthorization, precertification or prenotification) is required.
Clinical Information Notice
Requests for authorization must in all cases be accompanied by appropriate clinical or medical record information except for routine vaginal or cesarean section deliveries. Please submit clinical or 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 authorization, recommended clinical review (predetermination) and post-service review. Learn More
How to Request Prior Authorization or Recommended Clinical Review
Review the process to submit requests for prior authorizations and recommended clinical reviews. Learn More
Prior Authorization and Post-Service Review Lists
Download the lists of services and procedure codes that may require prior authorization or post-service reviews. Learn More