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Members

Preauthorization/Precertification Program

Helping you make the most of your benefits

Preauthorization is a program in which doctors and nurses collaborate to evaluate and monitor specific health care services.

The general purpose of the preauthorization program is to ensure all members receive:

  • Medically appropriate treatment to meet individual needs
  • Care by participating providers delivered in an efficient and effective manner
  • Maximum available benefits, resources and coverage

Capital BlueCross's Pre-Admission Call Program and Discharge Outreach Program are components of preauthorization.

Utilization Management staff is available to answer member questions related to the utilization management process during regular  business hours (8:00 AM to 6:00 PM Monday through Friday). A voicemail may be left after hours for a return phone call the next business day.

The criteria used in making a utilization management decision are available by calling 1.800.471.2242.