Prior Approval Authorization

Prior Approval / Pre-Notification / Pre-Service Requests - VERMONT

Requirements and Forms

Review the list of services, drugs and supplies that require approval prior to administration as well as the forms you will need to make a request.

 

Inpatient Pre-Notification

Scheduled inpatient admissions under all benefit programs require pre-notification. Learn how to obtain this approval.

 

Online Request Management

Online tools for managing prior approval and pre-notification requests, including services, procedures, radiology and pharmacy drugs.

 


Definitions

Prior Approval
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.

Pre-notification
Review conducted by Blue Cross and Blue Shield of Vermont before a member's admission to a Blue Cross and Blue Shield of Vermont contracted inpatient facilities, 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.

Pre-admission review
Review conducted by Blue Cross and Blue Shield of Vermont prior to member admission, to determine if prior approval or pre-notification is required.