Authorizations

Prior authorization is the requirement that a physician or other qualified provider obtain approval from Blue Shield before prescribing a specific medication, procedure and/or service.

 

Authorization tools

Blue Shield providers can submit medical and pharmacy authorizations online in AuthAccel. Blue Shield Promise providers can submit medical authorizations online, but pharmacy requests must be faxed.

The status of all medical and pharmacy requests can be viewed in AuthAccel for both Blue Shield and Blue Shield Promise members, regardless of how they are submitted.

Below are instructions for using AuthAccel.

 Request a medical authorization (PDF, 326 KB)

 View medical authorization status (PDF, 270 KB)

 Request a pharmacy authorization (PDF, 251 KB)

 View pharmacy authorization request (PDF, 177 KB)

 AuthAccel frequently asked questions (PDF, 281 KB)

Authorization basics for providers

Learn how to submit medical and pharmacy authorization requests.

Is authorization required for a Blue Shield of California member

See if medical service requires prior authorization.

Request medical authorization

Submit your medical requests online via AuthAccel.

View medical authorization status

Check the status of medical authorization requests you’ve submitted.

Request pharmacy authorization for Blue Shield members

Submit your pharmacy requests online via AuthAccel.

View pharmacy authorization status

Check the status of pharmacy authorization requests you've submitted.

Request pharmacy prior authorization electronically

Submit requests with CoverMyMeds®, an electronic prior authorization provider.

 

Managing out-of-area Blue plan members

Find tools, information, and resources to assist you in serving your patients insured by other state Blue plans.

Pre-service review

Access online tools to verify medical policy, determine pre-service requirements, request authorization.

BlueCard Program

Find information and tools you need to serve patients covered by other Blue plans.

 

Clinical policies and guidelines

Find policy information about medications and medical procedures, devices and technologies, learn about our prior authorization procedures, and access our outpatient drug formulary.

Drug formularies and policies

Search drug formulary database and find policy info on oral, topical and home-injectable drugs.

Medical policies and procedures

Learn about our medical policies, policy goals and new technologies coverage decisions process.

Medication policy

Read about our medication policies for Medicare and Commercial members.

Policy and prior authorizations for out-of-state members

Find medical policy and general prior authorization requirements.

 

Prior authorization forms and list

View, download and print authorization fax forms for medical services and injectable, oral, and topical drugs. Learn what medical services need authorization and where to obtain it.

Prior authorization forms for Blue Shield members

Download and print prior authorization forms for procedures and drugs.

Prior authorization list for Blue Shield (including Medicare 65+) and FEP members

Search a list of medical services and procedures requiring prior authorization.

Prior authorization forms for Blue Shield Promise members

Download prior authorization forms for procedures and drugs.

Prior authorization list for Blue Shield Promise members

Search a list of medical services and procedures requiring prior authorization.

 

Additional resources

Learn to use AuthAccel and find out who to contact if you have questions about prior authorizations.

AuthAccel training and info

Learn to use AuthAccel, Blue Shield's online prior authorization system.

Authorizations contacts

See phone numbers, addresses, and more.

IPA authorization log upload

Submit logs of approvals, denials, and partial denials for a medical or pharmacy service.

© California Physicians' Service DBA Blue Shield of California 1999-2024. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association. Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.

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