Prior authorization list

The prior authorization list is a resource for providers that lists the designated medical and surgical services and select prescription drugs which require prior authorization under a Blue Shield of California Promise Health Plan medical benefit. This list also includes specific equipment, services, drugs, and procedures requiring review or supplemental documentation prior to payment authorization.

Prior authorization for the services listed below is highly recommended. If authorization was not obtained prior to the service being rendered, the service will likely be reviewed for medical necessity at the point of claim.

While the list below covers the medical services, drugs, and procedures that require authorization prior to rendering a service, Blue Shield Promise may require additional information after the service has been provided. If we require further information to process the payment, Blue Shield Promise’s Claims Department will request specific information at that time. Please include medical records when you respond to a request from Blue Shield Promise’s Claims Department.

Please review our clinical policies and procedures and verify that any service you are going to provide a Blue Shield Promise member is a covered benefit. You may review our medical policies online or contact Provider Services, available at (800) 468-9935, 24 hours a day, seven days a week.

If prior authorization was obtained and you are submitting an offline (i.e., paper) claim, remember to attach a copy of the prior authorization letter.

Effective January 1, 2023, Cal MediConnect plans were discontinued throughout California. Blue Shield Promise Cal MediConnect members in Los Angeles and San Diego counties were transitioned to the Blue Shield TotalDual (HMO D-SNP) plan.

Prior authorization code lists

Medi-Cal/Cal MediConnect prior authorization codes
The documents below list prior authorization codes for Blue Shield Promise Medi-Cal and Cal MediConnect member services.