Prior Approval Authorization

Acuity Connect is a portal designed to allow providers the ability to view and submit prior approval and pre-notification requests electronically. The portal allows providers to see the status and documentation associated with the authorization submitted. You can access Acuity Connect via the Provider Resource Center.

We provide benefits for certain services, drugs, and supplies, only if approval is obtained in advance. This ensures the procedures are diagnostically appropriate, medically necessary and cost effective. In addition, pre-notification of scheduled inpatient admissions is required under all benefit programs.

Details and paper forms are listed below for our Prior Approval and Inpatient Pre-Notification processes.

Prior Approval Authorization Resources

There is a list of services, drugs and supplies that require approval from Blue Cross and Blue Shield of Vermont prior to administration and/or admission. If you do not get approval from Blue Cross and Blue Shield of Vermont before administration, benefits may be reduced or denied.

If marking a Prior Approval Request as urgent, please note:

  • Marking a request as “urgent” does not guarantee immediate review; state guidelines permit us up to 48 hours to review a request marked as “urgent” (or one that is automatically treated as urgent under state rules).
  • The most appropriate time to mark a request as “urgent” will be in situations involving urgently needed care (as defined by state regulations).
  • We must respond to all prior approval requests within two business days, whether they are marked “urgent” or not.
  • Please remember to submit requests before the member’s appointment.
  • Please ensure a request for prior approval is complete and contains required clinical information, as this will expedite the process.

If using one of the paper forms below, fax the completed prior approval form(s) to (866) 387-7914.


Additional Prior Approval Forms


Resources


BlueCard Members

To look up out-of-area member's prior approval/pre-notification/pre-certification/pre-service requirements, please use the Medical Policy Router located at the bottom of the Provider Policies page.

Pre-notification is a review conducted by Blue Cross and Blue Shield of Vermont before a member's admission to a facility for inpatient care, to confirm the appropriateness of the requested level of care and to assist with discharge planning and coordination of care for services not requiring prior approval.

We collect clinical information pertinent to the admission request. The information is reviewed in conjunction with nationally recognized health care guidelines. Providers are verbally notified of the determination of pre-notified services within three business days after obtaining all necessary information.

You can complete pre-notification in one of three ways:

  1. Submit pre-notification requests electronically via Acuity Connect by logging in to the Provider Resource Center
  2. Download the prior approval form; fax the completed prior approval form(s) to (866) 387-7914
  3. Call us directly for a pre-notification request. If calling, have the member name and certificate number ready, as well as the clinical details. Call us at (800) 922-8778

Additional Forms


BlueCard Members

To look up out-of-area member's prior approval/pre-notification/pre-certification/pre-service requirements, please use the Medical Policy Router on the Provider Polices page.

man with child outside

Provider Handbook

Access our Provider Handbook for a comprehensive reference of resources and requirements for Blue Cross providers.

Provider Handbook