Blue Cross and Blue Shield of Florida dba Florida Blue Prior Authorization

Blue Cross and Blue Shield of Florida dba Florida Blue prior authorization rules are often service-specific rather than universal, so the safest workflow is to confirm the requirement in the payer's provider resources before scheduling or submitting care. The notes below summarize the most actionable provider-side guidance captured in the research set for this payer.

At a glance

• Florida Blue routes provider prior authorization requests through Availity for many services; the provider page states that providers can request authorizations and referrals online via Availity, and the prior-authorization page specifically says the doctor must submit a request via Availity.com for certain services. The member-facing guidance also states emergency services do not require prior authorization, and that approval time varies by service. For medical/pharmacy drug prior authorization, some products are handled through Prime Therapeutics/Magellan channels rather than standard Availity workflows.
• Requirements vary by line of business and service category.
• The provider manual is not complete and may be updated by bulletin or posting.
• Some pharmacy/medical injectable programs use separate delegate/vendor processes.

Where to verify prior authorization requirements

• Verification resource 1
• Verification resource 2
• Verification resource 3

How to submit prior authorization requests

• Availity online portal

• Phone for certain medical/pharmacy drug prior authorization programs

• Plan-specific delegate/vendor workflows for certain drug programs

• Submission resource 1

• Submission resource 2

Information commonly required

• Patient/member information
• Service/procedure requested
• Clinical rationale / medical necessity support
• Provider information
• For some services, supporting documentation may be needed; Florida Blue says continuation requests require appropriate documentation from the provider

Turnaround notes and caveats

• Florida Blue states approval time can vary by the medical service requested.
• Emergency services are excluded from prior authorization requirements.
• Requirements vary by line of business and service category.
• The provider manual is not complete and may be updated by bulletin or posting.
• Some pharmacy/medical injectable programs use separate delegate/vendor processes.

Provider resources

• Provider Manual (official)
• Provider Prior Authorization (official)
• Provider Availity Online Services (official)
• Provider News (official)
• Claims / Using Your Coverage: Claims (official)
• Transparency in Coverage (official)

Sources