For Providers: How Do I Submit a Drug Prior Authorization Request for Medicare Plus Blue PPO and BCN Advantage?

Need to treat a Blue Cross Medicare Plus BlueSM PPO and BCN AdvantageSM HMO-POS or BCN Advantage patient with medical drugs at a provider office, an outpatient facility location or the patient’s home? You'll need to submit a prior authorization request and follow our medical policies to avoid a rejected claim. 

You can submit your request by logging in to the provider portal or using Novologix. If you don't have access to the provider portal, learn how to get an account. In the meantime, you can submit your prior authorization request by locating the appropriate form on this page and faxing it.

Drugs that require prior authorization

You can find which drugs need prior authorization by viewing our Medicare Advantage Medical Drug Prior Authorization and Step Therapy List (PDF). It includes Healthcare Common Procedural Coding System, or HCPCS, codes. It also lists generic and brand names for each drug.

Medical policies and prior authorization request forms

View our medical policies to learn about our drug guidelines. Also, view our Blue Cross Medicare Plus Blue PPO and BCN Advantage medication prior authorization request forms to fax your request.

Looking for a generic medication authorization request form? You can submit a global request form (PDF).

Medicare Plus Blue PPO and BCN Advantage

 

Medicare Plus Blue PPO and BCN Advantage

You can submit a prior authorization request through logging in the provider portal or by faxing one of the following:

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