Blue Cross and Blue Shield of Florida dba Florida Blue
Blue Cross and Blue Shield of Florida dba Florida Blue Prior Authorization
Florida Blue routes provider prior authorization requests through Availity for many services; the provider page states that providers can request…
Short answer
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…
Blue Cross and Blue Shield of Florida dba Florida Blue publishes service-specific prior authorization guidance. Start with the payer resource below, then confirm the member's plan and the requested service before care is scheduled or submitted.
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
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
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
| Fact | Value | Source | Confidence |
|---|---|---|---|
| Availity used for authorizations | Verify eligibility and benefits, request authorizations and referrals, submit claims, check claim status and more. | Official | high |
| Prior authorization request via Availity | Your doctor must submit a request to Florida Blue via Availity.com. | Official | high |
| Approval time varies | The approval time can vary based on the medical service you need. | Official | high |
| Emergency services exception | Prior authorization is not required when emergency services are rendered for the treatment of an emergency medical condition. | Official | high |
| Continuation requests need documentation | To request a continuation we must receive appropriate documentation from your Provider. | Official | medium |
Last reviewed: March 27, 2026
Sources used: 4 official
Automating prior authorization work
Clark Street Health is testing early-access workflows for requirements checks, status follow-up, document routing, and staff exceptions. Payer rules and clinical decisions still need the controls defined by your practice.
Review the prior authorization workflow