Health Options, Inc. dba Florida Blue Prior Authorization

Health Options, Inc. 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 states that prior authorization is required for certain services and some drugs; the specific requirements vary by plan, service, and line of business. For many medical services, the provider must request prior authorization through Availity before scheduling a procedure. For select medical/pharmacy drugs, Florida Blue instructs providers to contact Florida Blue or delegated entities by phone, and some services use specialty programs noted in provider communications and the provider manual.
• Requirements vary by plan and service type.
• Emergency services are treated differently; prior authorization is not required for some emergency/inpatient scenarios.
• Provider manual and bulletin updates may supersede older guidance.

Where to verify prior authorization requirements

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

How to submit prior authorization requests

• Availity.com / Availity Essentials for many medical prior authorizations and referrals

• Phone for some pharmacy/medical drug prior authorization requests

• Delegated vendor workflows where applicable

• Submission resource 1

• Submission resource 2

Information commonly required

• Member identification information
• Service/procedure details
• Ordering provider information
• Rendering/location information
• Clinical information supporting medical necessity
• Authorization number when sending records for review or follow-up

Turnaround notes and caveats

• No single turnaround time was confirmed on the public provider pages reviewed.
• Florida Blue indicates requests are reviewed and an approval or denial letter is mailed to the member.
• Status may be checked via the member ID-card customer service number or customer service contacts.
• Requirements vary by plan and service type.
• Emergency services are treated differently; prior authorization is not required for some emergency/inpatient scenarios.
• Provider manual and bulletin updates may supersede older guidance.

Provider resources

• Provider Manual (official)
• Provider Billing (official)
• Provider Prior Authorization (official)
• Provider Availity Online Services (official)
• Provider News - Bulletins and FAQs (official)
• Contact Us: Quick Reference Guide (official)

Sources