Overview
Each BCBS state plan has its own authorization portal. Most plans use Availity as the primary portal for prior auth submissions, but some states have proprietary systems. You need your NPI, tax ID, and the member's plan details to submit.
Key Requirements
- Availity (most plans): register at availity.com with your NPI and tax ID. Free registration.
- State-specific portals: BCBS of Illinois uses HCSC portal, BCBS of Michigan uses BCBSm.com, CareFirst uses carefirst.com.
- Required for submission: patient member ID, provider NPI, ICD-10 diagnosis, CPT procedure code, clinical notes.
- BlueCard members: submit auth to your local BCBS plan, which routes to the home plan.
- Track existing auth status through the same portal used for submission.
Timeline
Day 1: Register on Availity or state-specific portal (one-time setup, 1-3 business days). After registration: Submit auth request with clinical documentation. Standard decisions: 15 calendar days. Urgent decisions: 72 hours. Auth tracking: real-time status updates on portal.
Common Denials
| CARC Code | Reason | Primary Cause | Fix |
|---|---|---|---|
| CO-197 | Precertification not obtained | Auth not on file for service | Submit auth 10+ days before service |
| CO-50 | Non-covered service | Service outside plan coverage | Verify coverage on portal before auth |
| CO-16 | Claim differs from auth | Billed code does not match authorized code | Verify authorized CPT codes before billing |
Appeals
Appeal denied authorizations through the same portal used for submission. Each BCBS plan has its own appeal timeline, typically 60-180 days from the denial notice. Include clinical documentation and a letter explaining medical necessity.
FAQ
Which BCBS portal do I use for prior auth?
Start with Availity (availity.com), which connects to most BCBS plans. If your state plan uses a proprietary system, the member's ID card will list the correct portal URL. Contact your local BCBS provider relations for access.
Can I submit prior auth for BlueCard members?
Yes. Submit the auth request to your local BCBS plan through your regular portal. Your local plan coordinates with the member's home plan for the authorization decision.
How long does BCBS portal registration take?
Availity registration takes 1-3 business days for identity verification. State-specific portals vary. Some approve same-day; others take up to 5 business days.
Prevent These Denials
Altair pulls BCBS authorization requirements automatically, regardless of which state plan the member belongs to.