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Prior Authorization Quick Lookup
Please refer to our PA Requirement Disclaimers and PA Status Disclaimers to understand the intended use of these tools, including any limitations
Use this tool to determine if an outpatient service, item, or provider-administered medication requires authorization or to check the status of an authorization or referral already requested for a specific member.*
*Federal Employee Program members with out-of-state plans may not display in our tools.
Quick Lookup FAQ
What’s required to use the Quick Lookup tool?
You must complete all of the fields in the tool so that we can provide an accurate answer. We recommend having the following ready:
- Member name
- Member health plan ID
- Member date of birth
- Procedure code (CPT®′ or HCPCS) for the service that you’re checking on
- Diagnosis code
- Authorization # (if checking the status)
Once I know that authorization is required, how do I request authorization with Blue Cross Blue Shield of Massachusetts?
If authorization is required, we’ll provide you with information on how to request it, including the names of any independent companies that manage authorizations on our behalf. If you’re a Blue Plan participating provider, please use your local Blue Plan’s provider portal. Navigate to the Electronic Provider Access (EPA) tool to connect with authorization capabilities. If you have questions about navigation, please contact your Local plan.
If you’re a Blue Cross Blue Shield of Massachusetts participating provider, you must either request authorization with the company that manages the request on our behalf or you may use Authorization Manager* at bluecrossma.com/provider.
*For Medicare Advantage, use of Authorization Manager is encouraged, but not required.
