Frequently Asked Questions about Precertification

Additional Precertification Requirements for Outpatient Hospital Benefits, Physician Benefits and Other Covered Services

This webpage applies only to Blue Cross and Blue Shield of Alabama individual and family (non-group) plans and underwritten employer group plans. To determine if your employer plan is subject to these additional precertification requirements, your benefit booklet will say “the plan benefits are underwritten” in the Administrative Section at the end of your benefit booklet.

What is precertification?

Precertification is a determination by your health plan that the recommended medical service, supply or drug meets the definition of medical necessity under your plan. Precertification must be done prior to you receiving the recommended medical service, supply or drug. The definition of medical necessity can be found in the Definitions section of your benefit booklet.

Who initiates the precertification process?

In some cases, your provider will handle the process for you. You should check with your provider to see if he or she has received precertification. It is your responsibility to ensure that you or your provider gets precertification.

What services require precertification?

Please see your benefit booklet to determine what services require precertification under your plan. If you are covered under an underwritten plan and your benefit booklet refers you to for additional precertification requirements, the following services or supplies require precertification under your plan:

  • Effective 3/1/2020, genetic laboratory testing

Are there any prescription medications that required precertification?

Yes, precertification is required for certain prescription drugs. You can find a list of the drugs that require precertification in the Prescription Drug Guide. This list will be updated monthly. For precertification, call the Customer Service Department number on the back of your ID card.

For precertification, call 1-866-803-8002(toll free)