Coming Soon: Utilization Management - New Home for Prior Authorization Information

November 26, 2020

Beginning 2021, Prior authorization will be under Utilization Management in the Claims and Eligibility section on our website. Utilization management is at the heart of helping you determine medical necessity. It also helps our members get the right care, at the right place and at the right time. A utilization management review determines whether a service is medically necessary under the health plan using evidence-based clinical standards of care.

Utilization management includes:

  • Prior Authorization
  • Predeterminations
  • Post-service reviews

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.

If you have questions, Email provider inquiries or call the Provider Contract Support Unit at 800-722-3730, Option 2.

Please Note: For Claims issues/inquiries, please call 1-800-722-3730 Option 1 or verify claim status online Learn more about third-party links

Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association