ATTENTION: If you speak a language other than English, language assistance services are available to you free of charge. Call 1-800-200-4255 (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia con el idioma. Llame al número de Servicio al Cliente que figura en su tarjeta de identificación llamada 1-800-200-4255 (TTY: 711 ).
ATENÇÃO: Se fala português, são-lhe disponibilizados gratuitamente serviços de assistência de idiomas. Telefone para os Serviços aos Membros, através do número no seu cartão ID chamar 1-800-200-4255 (TTY: 711 ).
ATTENTION : si vous parlez français, des services d’assistance linguistique sont disponibles gratuitement. Appelez le Service adhérents au numéro indiqué sur votre carte d’assuré appel 1-800-200-4255 (TTY : 711 ).
注意：如果您讲中文，我们可向您免费提供语言协助服务。请拨打您 ID 卡上的号码联系会员服务部 通话 1-800-200-4255（TTY 号码：711 )。
ATANSYON: Si ou pale kreyòl ayisyen, sèvis asistans nan lang disponib pou ou gratis. Rele nimewo Sèvis Manm nan ki sou kat Idantitifkasyon w lan (Sèvis pou Malantandan Rele 1-800-200-4255 TTY: 711 ).
LƯU .: Nếu quý vị n.i Tiếng Việt, c.c dịch vụ hỗ trợ ng.n ngữ được cung cấp cho quý vị miễn ph.. Gọi cho Dịch vụ Hội vi.n theo số tr.n thẻ ID của quý vị Cuộc gọi 1-800-200-4255 (TTY: 711 ).
ВНИМАНИЕ: если Вы говорите по-русски, Вы можете воспользоваться бесплатными услугами переводчика. Позвоните в отдел обслуживания клиентов по номеру, указанному в Вашей идентификационной карте вызов 1-800-200-4255 (телетайп: 711 ).
ការជូនដំណឹង៖ ប្រសិនប. ើអ្នកនិយាយភាសា ខ្មែរ សេ វាជំនួយភាសាឥតគិតថ្លៃ គឺអាចរកបានសម្ រាប ់អ្នក។ សូមទូរស័ព្ទទ ៅផ ្នែ កសេ វាសមា ជិកតាមល េខន ៅល. ើប ័ណ្ណ សម្ គាល ់ខ្លួ ខ្លួ នរប ស់អ្នក ហៅ 1-800-200-4255 (TTY: 711) ។
ATTENZIONE: se parlate italiano, sono disponibili per voi servizi gratuiti di assistenza linguistica. Chiamate il Servizio per i membri al numero riportato sulla vostra scheda identificativa chiamata 1-800-200-4255 (TTY: 711 ).
참고 : 한국어를 사용하는 경우 언어 지원 서비스를 무료로 사용할 수 있습니다. 신분증에있는 전화 번호 1-800-200-4255 (TTY : 711)로 회원 서비스에 연락하십시오.
ΠΡΟΣΟΧΗ: Εάν μιλάτε Ελληνικά, διατίθενται για σας υπηρεσίες γλωσσικής βοήθειας, δωρεάν. Καλέστε την Υπηρεσία Εξυπηρέτησης Μελών στον αριθμό της κάρτας μέλους σας (ID Card) κλήση 1-800-200-4255 (TTY: 711 ).
UWAGA: Osoby posługujące się językiem polskim mogą bezpłatnie skorzystać z pomocy językowej. Należy zadzwonić do Działu obsługi ubezpieczonych pod numer podany na identyfikatorze zadzwoń 1-800-200-4255 (TTY: 711 ).
ध्यान दें: य दि आप ह िन् दी बोलते ह ैं, तो भा षा सहाय ता सेवा एँ, आप के लि ए नि :शुल्क उपलब्ध ह ैं। सदस्य सेवा ओं को आपके आई.डी. कार ्ड पर दि ए गए नंबर पर कॉल करें कॉल 1-800-200-4255 ( टी .टी .वा ई.: 711).
ધ્યાન આપો: જો તમે ગુજરા તી બોલતા હો, તો તમને ભા ષા કીય સહાય તા સેવા ઓ વિ ના મૂલ્યે ઉપલબ્ધ છે. તમા રા આઈડી કાર ્ડ પર આપેલા નંબર પર Member Service ને કૉલ કરો કૉલ કરો 1-800-200-4255 (TTY: 711).
PAUNAWA: Kung nagsasalita ka ng wikang Tagalog, mayroon kang magagamit na mga libreng serbisyo para sa tulong sa wika. Tawagan ang Mga Serbisyo sa Miyembro sa numerong nasa iyong ID Card tumawag 1-800-200-4255 (TTY: 711 ).
お知らせ：日本語をお話しになる方は無料の言語アシスタンスサービスをご利用いただけます。ID カードに記載の電話番号を使用してメンバーサービスまでお電話ください 呼び出す 1-800-200-4255（TTY: 711 ）。
ACHTUNG: Wenn Sie Deutsche sprechen, steht Ihnen kostenlos fremdsprachliche Unterstützung zur Verfügung. Rufen Sie den Mitgliederdienst unter der Nummer auf Ihrer ID-Karte an Anrufen 1-800-200-4255 (TTY: 711 ).
ຂໍ້ຄວນໃສ່ໃຈ: ຖ້າເຈົ້າເວົ້າພາສາລາວໄດ້, ມີການບໍລິການຊ່ວຍເຫຼືອດ້ານພາສາໃຫ້ທ່ານໂດຍບໍ່ເສຍຄ່າ. ໂທ ຫາ ຝ່າຍບໍລິການສະ ມາ ຊິກທີ່ໝາຍເລກໂທລະສັບຢູ່ໃນບັດຂອງທ່ານ ໂທ 1-800-200-4255 (TTY: 711).
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Medical authorization requests – How to:
- Determine if medical authorization is required for a Commercial/FEP PPO member.
- Determine if medical authorization is required for a Medicare, Medi-Cal, or Cal MediConnect member.
- Submit a medical authorization request and check status for all plan types.
Pharmacy authorization requests – How to:
- Determine if pharmacy authorization is required for a Commercial member.
- Determine if pharmacy authorization is required for a Medicare, Medi-Cal, or Cal MediConnect member.
- Submit a pharmacy authorization for a FEP PPO member or check if one is required.
- Submit a pharmacy authorization for a Commercial or Medicare member and check status.
- Submit a pharmacy authorization for a Medi-Cal or Cal MediConnect member and check status.
Determine if medical authorization is required for a Commercial/FEP PPO member.
AuthAccel can tell you when a medical authorization is not required for a Blue Shield Commercial/FEP member or if it is delegated to another approver. Note, behavioral health falls under the medical benefit. When either is the case, completing and submitting the request in AuthAccel will result in an inquiry. You must complete the process and click the Submit button to secure an inquiry number. You can download and/or print the inquiry for your records. When medical authorization is required by Blue Shield, you can complete and submit the request in AuthAccel. Please see the Request a Medical Authorization (PDF, 329KB) instructions for additional detail.
You can also view Blue Shield’s prior authorization list or contact Blue Shield of California Provider Services to determine if medical authorization is required.
Determine if medical authorization is required for a Medicare, Medi-Cal, or Cal MediConnect member.
While you can submit an authorization in AuthAccel for a Medicare, Medi-Cal or Cal MediConnect member, the system cannot tell you if the request is required or delegated.
To determine if medical authorization is required for a Medicare member, please consult the prior authorization list or call Blue Shield of California Provider Services at (800) 541-6652. Note, behavioral health falls under the medical benefit.
To determine if medical authorization is required for a Medi-Cal or Cal MediConnect member, please consult the Prior Authorization Code Lists located on the Prior authorization list page, or call Blue Shield Promise Health Plan at (800) 468-9935.
Submit a medical authorization request and check status for all plan types.
Medical authorizations for Blue Shield of California and Blue Shield Promise Health Plan members, including requests for behavioral health services, can be submitted online in AuthAccel. Medical authorization status can also be viewed online, regardless of how the request is submitted. Detailed instructions for how to submit medical authorizations and check their status in AuthAccel are available from the links above as well as from the AuthAccel online authorization training page.
Additionally, medical authorization requests for Commercial/FEP PPO and Medicare members can be faxed, and in some cases, phoned in. To obtain a fax form, visit the Prior authorization forms page. For telephone contacts, please see the Blue Shield of California Member Authorizations section on the Authorization contacts page.
Medi-Cal and Cal MediConnect medical authorization requests can also be faxed, and in some cases, phoned in. To obtain a fax form, visit the Provider forms page. For telephone contacts, please see the Blue Shield Promise Member Authorizations section on the Authorization contacts page.
Determine if pharmacy authorization is required for a Commercial member.
To determine if pharmacy authorization is required, navigate to the Blue Shield Outpatient drug formulary page and select the Blue Shield of California IFP, Small Group, Large Group, and Medicare formularies link.
- For Commercial members, scroll to either the Individual and Family Plan/Small Group section or the Large Group section, then click the appropriate plan’s drug formulary link.
- For Medicare members, click the Medicare Part D prescription drug formularies link, then select the appropriate plan.
- All formularies allow search by drug name and by therapeutic class. Once you search for and locate a drug:
- The drug details screen will display with a legend that defines the symbols used in the online formulary. To collapse this legend, click the down arrow.
- The symbol “PA” means that prior authorization is required.
For drug formulary information for Commercial and Medicare member outpatient prescription drugs and home self-administered injectables, call (800) 535-9481.
Determine if pharmacy authorization is required for a Medicare, Medi-Cal, or Cal MediConnect member.
To determine if pharmacy authorization is required, navigate to the Blue Shield Promise Pharmacy services and drug formulary page, scroll to the Drug Formularies section, and click the appropriate formulary link. For Medicare members, you will also need to select the member’s plan.
- All formularies allow search by drug name and by therapeutic class. Once you
search for and locate a drug:
- The drug details screen will display with a legend that defines the symbols used in the online formulary. To collapse this legend, click the down arrow.
- The symbol “PA” means that prior authorization is required.
For drug formulary information for Medi-Cal and Cal MediConnect member outpatient prescription drugs and home self-administered injectables, call (800) 468-9935.
Submit a pharmacy authorization for a FEP PPO member or check if one is required.
CVS Caremark is the program administrator for FEP PPO member retail drugs and is responsible for assisting with prior authorization. Visit the Blue Cross Blue Shield Federal Employee Program Prescription Drugs page for formulary information and approval forms or call a number below:
- Retail Pharmacy Program: 800-624-5060, TTY: 800-624-5077
- Specialty Drug Pharmacy Program: 888-346-3731, TTY: 877-853-9549
Submit a pharmacy authorization for a Commercial or Medicare member and check status
Blue Shield providers that utilize the Surescripts® or CoverMyMeds® EHR platforms and have electronic prior authorization (ePA) functionality enabled on their systems, can submit ePA for their patients to request outpatient drug prior authorization. This capability provides a real-time response for drug authorizations at point of care. ePA can also identify drugs that do not require prior authorization and eliminate the need to complete and submit paper forms. Additionally, providers can access CoverMyMeds from this website.
Pharmacy authorization requests for Commercial and Medicare members can also be faxed to Blue Shield. Please see the Prescription drug prior authorization and step therapy exception request forms section on the Prior authorization forms page.
For drug formulary information and to request prior authorization for Commercial and Medicare member outpatient prescription drugs and home self-administered injectables, call (800) 535-9481.
Submit a pharmacy authorization for a Medi-Cal or Cal MediConnect member and check status.
Blue Shield Promise providers that utilize the Surescripts® or CoverMyMeds® EHR platforms and have electronic prior authorization (ePA) functionality enabled on their systems, can submit ePA for their patients to request outpatient drug prior authorization. This capability provides a real-time response for drug authorizations at point of care. ePA can also identify drugs that do not require prior authorization and eliminate the need to complete and submit paper forms. Additionally, providers can access CoverMyMeds from this website.
Pharmacy authorization requests for Medi-Cal and Cal MediConnect members can also be faxed to Blue Shield Promise. Please see the Authorization request forms section on the Provider forms page.
For drug formulary information and to request prior authorization for Medi-Cal and Cal MediConnect member outpatient prescription drugs and home self-administered injectables, call (800) 468-9935.