Contracted facilities are required to obtain pre-authorization or pre-certification for inpatient admissions for BlueCard members from the member's Plan in accordance with each member's Plan requirements.
- Pre-authorization or pre-certification must be received by the member's Plan within 24 hours after the actual weekday admission (or by 5:00 p.m. local time on the next business day, if 24 hour notification would require notification on a weekend or a federal holiday).
- The member's Plan must be notified of any changes or modifications to a pre-service review for out-of-area BlueCard members within 48 hours or within 72 hours for emergent/urgent admissions when the length of an inpatient hospital stay extends past the previously approved length of stay.
- Failure to obtain a pre-authorization or pre-certification for required inpatient admissions occurring or failure to notify member's Plan of modifications to a pre-service review will result in claim non-payment for services provided by the facility and is a write-off.
- The member must be held harmless and cannot be balance-billed if the above pre-authorization or pre-certification requirements have not been followed.
Determining pre-authorization or pre-certification requirements for BlueCard members
Pre-authorization or pre-certification contact information for a member's Plan is provided on the BlueCard member's identification card. Pre-authorization or pre-certification requirements for a particular member can be determined electronically, online or by phone.
- Use the Electronic Provider Access (EPA) tool available in the Availity portal. With EPA, you can gain access to an out-of-area member's Home Plan provider portal, through a secure routing mechanism and have access to electronic pre-service review capabilities.
- Use our online tool to be automatically routed to the home plan's pre-authorization / pre-certification requirements. Launch the tool.
Call BlueCard Eligibility at 1 (800) 676-BLUE (2583). You will be asked for the member's prefix and the type of service for which you are calling:
- Behavioral health
- Diagnostic imaging/radiology
- Durable medical equipment (DME)
Upon making your selection, you will be connected to the appropriate Blue Plan.
Submit an ANSI 278 transaction (referral/authorization) to Regence. The majority of BlueCard electronic inquiries are answered within 48-72 hours (Monday through Friday during regular office hours).