Prior authorization for requested services

The primary coverage criteria of certain services must be established through a prior approval or pre-authorization process before they can be performed. Please refer to Availity Essentials portal, Arkansas Blue Cross Coverage Policy or the member’s benefit certificate to determine which services need prior authorization.

Important information

• FEP utilizes Magellan Rx Management for medical specialty pharmacy prior authorization.
• Providers who are requesting a prior authorization for BlueMedicare members should use the appropriate form from Medicare Advantage Prior Authorization Request Form.
  • Providers requesting prior authorization for Part B drugs for BlueMedicare should use the Part B Medication Prior Approval Request Form.
  • Medicare Advantage - eviCore Innovative Solutions - Durable Medical Equipment, High-Tech Radiology and Radiation Oncology Guidelines.

  What to include with the completed Authorization | Organizational Determination Request Form [pdf]

  Please fill out the form in its entirety and include all relevant clinical documentation to support the request.

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