Prior Authorization Forms

Prior Authorization Requests

Use our tool to see if prior authorization is required. Select a line of business to see the the list of prior authorizations related to the member details selected. The member prefix can be found on the member ID card, before the member ID number.

Select Line of Business or Member Prefix*

The following services require Prior Authorization (or notification):

  • All scheduled elective surgical admissions
  • All medical admissions
    • Acute Inpatient (hospital) admissions
    • Acute Rehab facilities
    • Inpatient Hospice
    • Long-term care facilities (LTAC & SNF)
  • All Clinical Trials
  • All items and services from out-of-network providers require prior authorization.
  • All Organ and Tissue Transplants (excluding corneal transplants)
  • Chiropractic services performed by an out-of-network provider
  • Exceeding OT/PT/ST Benefit Limits for Developmental and Physical Disorders
Note: A Blue KC Provider Account is required for submitting a prior auth. Find account details, BlueKC eForms, and fax information on Additional Resources. If a code cannot be located, you may still request a prior auth. Code lists are subject to change.

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