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Blue Cross and Blue Shield of Louisiana, an independent licensee of the Blue Cross and Blue Shield Association, offers Blue Advantage (PPO). The purpose of this form is to request a prior authorization for outpatient services and Part B drugs. Please fax this completed form to 1-877-528-5816, Attn. Medical Management.
Fax each completed Predetermination Request Form to 800-852-1360. If unable to fax, you may mail your request to BCBSIL, PO BOX 805107, Chicago, IL, 60680-3625.
Musculoskeletal prior authorization is required for spinal surgery, joint surgery (hip, knee and shoulder) and pain management. You can request prior authorization at Availity.com or by fax at 1-866-747-0587.
High Tech Imaging This includes: CT, CTA, MRI, MRA, MRS, Nuclear Cardiac, PET and CPT. You can verify benefits and request prior authorization at Availity.com or by phone at 1-888-693-32111-888-693-3211 or by fax at 1-888-693-3210.
Methods for Requesting Prior Authorization If you do not have an account, request one here. Fax: 813-751-3760 Submit the Preauthorization Request Form along with supporting documentation.
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