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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.
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For BCBSMA employees, fax to 1-617-246-4013.
Prior authorization (PA) may be required via BCBSTXs medical management, eviCore healthcare, Carelon Medical Benefits Management or Magellan Healthcare. You can review how to submit PA or Notification requests and view PA statistical data here.
What is Prior Authorization? This means your doctor must explain in writing why you need a certain medication before Blue Cross NC can decide if it will be covered. Our drug search tool shows the restricted drugs our members use most, and the details your doctor or provider must send us to get them approved.
How can my provider request prior review and certification? Your health care provider can use any of the following ways to request prior review and certification: By phone: Blue Cross NC Utilization Management at 1-800-672-7897 Monday to Friday, 8 a.m. 5 p.m. ET. By fax: Request form.
Member Utilization Management Hours and Contact Information If your provider needs to contact us, he or she may call the Provider Service Hotline at 1-877-784-6802.
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People also ask

Including home health care services, durable medical equipment, behavioral health (mental health/substance use disorder) and the Prior Review List. The Avalon portal will not be available until 4/23. Please fax the completed form to Avalons Medical Management Department at 813-751-3760.
Just click on a form to download it. Have your doctor fax in completed forms at 1-877-243-6930.
How and when can I contact my health plan? Blue Cross NCs Customer Service representatives are available to answer calls at 1-877-258-3334, Monday through Friday from 8:00 a.m. to 7:00 p.m.
How You Can Request Prior Authorization. Check with us to see if your provider has requested prior authorization before you get any services. If your health care provider has not requested prior authorization, you can request it. Call the number on your BCBSTX member ID card.
How can I submit a prior authorization to a health plan? Urgent: Call 866-799-5318 and follow the prompts. Use the Prior-Auth Check Tool on the website to quickly determine if a service or procedure requires prior authorization. This tool will go live later this summer, before the launch of NC Medicaid Managed care.

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