Authorizations

Authorizations for Blue Shield PPO members

Submit medical, medical benefit drug, and behavioral health authorization requests through Availity.com. You can also find general training modules on registration, how to submit authorizations, contacts for assistance, and more.

How to submit authorization requests

Authorizations for Blue Shield HMO members

Check with the member’s assigned IPA for next steps.

If you’re referred back to Blue Shield or you are a contracted network provider, use Blue Shield’s AuthAccel tool or contact us.

Authorizations for Blue Shield Promise (Medi-Cal) members

Medical and Medical Benefit Drugs

Check with the member’s assigned IPA for next steps.

If you’re referred back to Blue Shield or you are a contracted network provider, use Blue Shield’s AuthAccel tool or contact us. 

Outpatient/retail pharmacy

Since January 1, 2022, the state-run program Medi-Cal Rx began managing Medi-Cal pharmacy benefits. The Department of Health Care Services (DHCS) administers the Medi-Cal Rx program through their vendor, Magellan Rx. To learn more, visit the Medi-Cal Rx website any time or call (800) 977-2273, available 8 a.m. to 5 p.m. Pacific Time, Monday through Friday.

Prior authorization forms and lists

Find out which medical services need authorization and how to get it. View, download, and print required fax forms for medical services and injectable, oral, or topical drugs.

IPA authorization log

Submit logs of approvals, denials, and partial denials for a medical or pharmacy service through the IPA authorization log upload.

Out-of-area Blue Plan members

Go to pre-service review to find online tools to verify medical policy, determine pre-service requirements, and request authorization.

Visit BlueCard Program to find information and tools you need to assist patients covered by other Blue Plans.