Blue Cross Blue Shield - Maine Prior Authorization Lookup
- Blue Cross Blue Shield - Maine timely filing
- Blue Cross Blue Shield - Maine coverage criteria
- All Blue Cross Blue Shield - Maine policy updates
Latest Blue Cross Blue Shield - Maine prior authorization updates25
- Prior AuthClinical/Medical PolicyEff. 2026-07-28Abraxane (paclitaxel, protein bound) — Clinical Coverage CriteriaClinical coverage criteria for use of Abraxane (protein/albumin-bound paclitaxel) across oncology indications; governs prior authorization and medical necessity determinations for members.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01National Direct Plus Drug List (formulary)This document is the Blue Cross Blue Shield - Maine National Direct Plus Drug List describing the three-tier prescription drug formulary, how drugs are classified, and member resources for coverage and prior authorization; it applies to members enrolled in this pharmacy benefit plan.All Blue Cross Blue Shield - Maine updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-02-11Medicaid Procedure Code List — New York (prior-authorization code excerpts)This document section lists Medicaid procedure codes and brief descriptions (New York state) used for mapping or reference in reimbursement/payment policies; it affects claims coding and billing for NY Medicaid.All Blue Cross Blue Shield - Maine updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-02-11Medicaid procedure and HCPCS code listing (NY) — prior authorization catalogAll Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Anthem and CDHP products Precertification/Prior Authorization ListDefines services and procedures that require preapproval (precertification/prior authorization) for Anthem and CDHP products and identifies responsible parties and vendor-managed programs; applies to providers submitting requests for covered members in the included Blue Cross Blue Shield plan jurisdictions.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEff. 2026-01-01Bone Grafts for Surgical Services (Periodontal)Defines clinical appropriateness, required documentation, and coding for bone grafting procedures related to periodontal and peri-implant defects, affecting dental providers and prior authorization reviewers under the plan.All Blue Cross Blue Shield - Maine updates
- Prior AuthAdministrative/Operational PolicyEff. 2026-01-01Services Requiring Prior Authorization (Ohio MyCare Plan)Lists physical and behavioral health services that require prior authorization, notifications, or do not require authorization for Anthem Blue Cross and Blue Shield MyCare Ohio members; intended for providers and administrative staff managing prior auth for covered members.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEff. 2024-10-01Prior authorization form and coverage criteria — RSV prophylaxis (palivizumab/Synagis)Provider-completed prior authorization form and clinical criteria for monoclonal antibody RSV prophylaxis (palivizumab/Synagis) with guidance on PA submission, documentation, and eligibility for Medicaid populations served by the payer.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEff. 2024-01-01Orthodontia - Medically Necessary Orthodontia CareDefines criteria and documentation requirements for review and preauthorization of medically necessary orthodontic treatment for members whose contracts permit medical/dental necessity review; distinguishes medically necessary from cosmetic orthodontia.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEff. 2023-08-01Carelon expansion: Prior Authorization and Utilization Review for Cardiology, Genetic Testing, and RadiologyAnnouncement that Carelon Medical Benefits Management will perform medical necessity reviews and expanded prior authorization requirements for specified cardiology, genetic testing, and radiology procedures for Anthem Blue Cross members (local fully-insured and select ASO plans) effective August 1, 2023.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEff. 2023-01-01Orthodontia - Medically Necessary Orthodontia CarePolicy governing review and preauthorization criteria for medically necessary orthodontic treatment for members under applicable Blue Cross Blue Shield - Maine contracts; applies to providers requesting orthodontic benefits determination.All Blue Cross Blue Shield - Maine updates
- Prior AuthAdministrative/Operational PolicyEff. 2021-01-30Precertification / Prior Approval Requirements (Federal Employee Program)Governs when members must obtain precertification or prior approval from the Local Plan for inpatient admissions, outpatient procedures, specialty services (e.g., transplants, gene therapy, ABA), and certain mental health or residential treatment services for Blue Cross Blue Shield - Maine Federal Employee Program members.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyAnthem Medicaid Medical Necessity Code List (DX codes)A listing of diagnosis (DX) codes that Anthem Medicaid designates for medical necessity purposes; intended for providers billing Anthem Medicaid in the covered jurisdiction.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyAuthorization and Coverage Requirements for Formal Psychological TestingThis document governs prior authorization and clinical submission requirements for formal psychological testing requests for Blue Cross Blue Shield - Maine members; it affects psychologists and other providers requesting coverage for psychological testing. It excludes requests for placement, forensic, and educational testing for school purposes.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyAutism Spectrum Disorder (ASD) psychological testing requestsForm and policy governing prior authorization requests for formal psychological testing for ASD for members served by the payer; describes required clinical information, screening measures, and requested CPT codes. Affects providers submitting ASD testing requests.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyClinical UM PPO Guidelines (California) — Clinical Utilization Management Guidance (index of guideline entries)An index compilation of Clinical Utilization Management (UM) PPO guideline titles and control numbers used to indicate which clinical guideline documents and programs govern precertification and review processes for covered services for local fully‑insured and select ASO groups (excludes BlueCard, Medicare/Medicaid, Medicare Supplement, and FEP).All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyClinical UM PPO Guidelines for California (Catalog of Clinical Utilization Management Guidelines)A catalog of Clinical UM PPO Guidelines adopted for Anthem Blue Cross California commercial plans, describing which guideline documents are used for utilization management and which services may require prior authorization; applies to providers requesting precertification for affected members.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyClinical Utilization Management Guidelines (Directory of Clinical UM Criteria)A listing of Anthem/Anthem Blue Cross and Blue Shield Medicaid Clinical Utilization Management (UM) Guidelines and MCG usage notes that govern prior authorization and medical necessity review processes for covered services and providers.All Blue Cross Blue Shield - Maine updates
- Prior AuthAdministrative/Operational PolicyElectroconvulsive Therapy Prior Authorization Request FormA prior authorization request form and instructions for submitting authorization for electroconvulsive therapy (ECT) services for Anthem/Blue Cross Blue Shield lines serving Indiana populations; used by providers requesting initial or continuation ECT, inpatient or outpatient. Affects providers and administrative staff submitting ECT authorizations.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyEndocrine Therapy Prior Authorization Form — Breast Cancer Treatment and Risk ReductionA provider-facing authorization form governing prior authorization requests for select endocrine therapies (anastrozole, exemestane, letrozole, raloxifene, Soltamox, tamoxifen) for Blue Cross Blue Shield - Maine members. It applies to requests for these drugs and documents required clinical information to determine coverage.All Blue Cross Blue Shield - Maine updates
- Prior AuthAdministrative/Operational PolicyFEP Precertification / Prior Approval Requirements (Kentucky)Governs precertification and prior approval processes for the Federal Employee Program (FEP) benefit plan in Kentucky, specifying services that require prior approval and contact methods; affects members, providers, and facilities delivering inpatient, outpatient, mental health, transplant, ABA and other listed services.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyNeuropsychological Testing AuthorizationThis document governs prior authorization and request procedures for neuropsychological (psychometric) testing for Anthem/Blue Cross Blue Shield members in Maine, including clinical indications and required supporting information for providers submitting requests.All Blue Cross Blue Shield - Maine updates
- Prior AuthClinical/Medical PolicyPharmacy Prior Authorization Form — Coverage CriteriaForm and instructions to request prior authorization for medications (including medical injectables/oncology) for members in Anthem Blue Cross and Blue Shield Indiana programs; intended for prescribers, pharmacies, and billing facilities to submit PA requests. Payment remains subject to member eligibility, other health insurance, and program restrictions.All Blue Cross Blue Shield - Maine updates
- Prior AuthAdministrative/Operational PolicyPrecertification / Prior Approval RequirementsDefines prior approval (precertification) requirements and contact points for inpatient and selected outpatient services under the Service Benefit Plan (Federal Employee Program) as administered by the Local Plan; affects providers and members using the Local Plan where services are performed.All Blue Cross Blue Shield - Maine updates
- Prior AuthAdministrative/Operational PolicyPrecertification / Prior Approval RequirementsGoverns prior authorization (precertification/prior approval) requirements for inpatient and outpatient services under the Blue Cross Blue Shield Federal Employee Program (Service Benefit Plan) and related contract variations (Standard, Basic, Blue Focus). Affects members, providers, and Local Plans performing or arranging services.All Blue Cross Blue Shield - Maine updates
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Tool Description
Search Blue Cross Blue Shield - Maineprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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