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Providers

Prior approval for requested services

The primary coverage criteria of certain services must be established through a prior Approval or pre-authorization process before they can be performed. Please refer to AHIN, Arkansas Blue Cross Coverage Policy or the member’s benefit certificate to determine which services need prior approval.

What to include with the completed Prior Approval form [pdf]

  • Member Information
  • Requested service(s)
  • Name and telephone number of contact person
  • Fax number to send determination
  • Requesting / Performing Provider’s NPI or Provider ID
  • Copy of member’s insurance card (front/back)
  • Other Insurance Information
  • CPT Code(s), ICD 10/HCPCS Code(s), Modifiers that are applicable
  • Please use the most descriptive procedure and diagnosis codes
  • Medical records to support requested services