Medical Policy and Pre-Service Review for Out-of-Area Members*
(This includes notification, pre-certification, pre-authorization and prior approval for services and procedures
for members of Blue plans not contracted directly with the provider.)
* Not available for FEP or Medicare Advantage members.
Certain groups may have specific authorization requirements. Before viewing medical policies or initiating authorizations,
check the member's benefits
View Medical Policy
Each Blues plan has its own rules for determining medical necessity. Follow these steps:
1) Select the type of information being requested.
General pre-certification/pre-authorization information
2) Enter the first three characters of the member's identification number on the Blue Cross Blue Shield ID card, then click "Go".
Do not close this window, as you need to return to this page to complete the process.
Initiate Pre-Service Request
If you have verified the member's benefits and determined that a pre-service review is required, begin by again entering the first three characters of the member's identification number and clicking "Request Review."
If you experience difficulties or need additional information, please contact 1.800.676.2583.
Wellmark Blue Cross and Blue Shield of Iowa, Wellmark Health Plan of Iowa, Inc., Wellmark Blue Cross and Blue Shield of South Dakota, Wellmark Synergy Health, Inc., and Wellmark Value Health Plan, Inc. are independent licensees of the Blue Cross and Blue Shield Association.
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