Prior Approval Authorization

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 us before administration, benefits may be reduced or denied.

If marking a Prior Approval Request as urgent, please know that 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”. The most appropriate time to mark a request as “urgent” will be in situations involving urgently needed care (as defined by state regulations). Submitting the request before the member’s appointment and with the required clinical information can help expedite the process.

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

• State of Vermont Uniform Medical Prior Authorization Form
• Psychological/Neuropsychological Testing Additional Information Worksheet
  • This service requires completing the Prior Authorization form along with the worksheet

Additional Prior Approval Forms

• Radiology Services (elective) – CT, CTA, MRI, MRA, MRS & PET
• Pharmacy Services
  • Use CoverMyMeds (Member ID should include the last letter (usually V) followed by twelve numbers and the two-digit member number)
  • Call Vermont Blue Rx at (800) 313-7879

Resources

• Blue Cross and Blue Shield of Vermont Prior Approval (including New England Health Plan and Access Blue New England when applicable)
  • Services, Equipment & Supplies Requiring Prior Approval
  • Drugs Requiring Prior Authorization in the Medical Benefit
• Federal Employee Program Prior Approval
  • 2026 Federal Employee Program (Federal and Postal Employee) List of Prior Approval Requirements for Standard and Basic Options
  • 2026 Federal Employee Program (Federal and Postal Employee) List of Prior Approval Requirements for Blue Focus

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 on 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 the Prior Authorization Portal 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

• Census Reporting Requirements and Process
• Initial Inpatient Rehabilitation Worksheet
  • This service requires completing the Prior Authorization form along with the worksheet
• Inpatient Rehabilitation Continuation Worksheet
  • This service requires completing the Prior Authorization form along with the worksheet

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.

• Inpatient Prior Authorization Guide
• Outpatient Prior Authorization Guide
• Prior Authorization Portal User Guide