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Prior authorization 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 Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the member’s benefit certificate to determine which services need prior authorization.

What to include with the completed Authorization | Organizational Determination Request Form [pdf]


Please fill out the form in its entirety and include all relevant clinical documentation to support the request.