Authorization Manager

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Authorization Manager

Reminder

We have changed the number of units and days we will initially approve for partial hospitalization program (PHP) and intensive outpatient program (IOP) requests.

For PHP, you may request a maximum of 10 units over 14 days.
For IOP, you may request a maximum of 30 units over 60 days.

If there is a break in either service for seven days or longer, a new case is required. Please refer to our PHP and IOP guides in the Guides and video demonstrations section of this page.

If you don’t see a Go Now button, please contact the Provider Central account administrator in your office to give you access to this eTool. For more information, see our Provider Central Administrators Quick Start Guide.

To use this tool, simply log in, click on this page in the eTools tab, and look for the Go Now button. Not registered for Provider Central? Find out who can register.

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Key features

You can enter and verify referrals and authorization requests in Authorization Manager. This eTool offers:

	Useful search tools Search member-specific authorization requirements by code Search by provider number to look up referral and authorization status and view related correspondence
	Easy request submission Submit requests for mental health, medical, or surgical services (including oral surgery) Upload documentation to support clinical review Complete the InterQual® medical necessity checklist for certain procedures Add discharge date, disposition, and discharge diagnosis to inpatient requests
	Flexible status verification View the status of requests for all Massachusetts members* Check the status of requests submitted via Authorization Manager, phone, fax, and vendors such as Carelon Medical Benefits Management and WholeHealth Living, Inc., a Tivity Health Company
	Automatic approvals Receive automatic authorization for certain services (including but not limited to hip, knee, or spine surgery) if InterQual criteria are met and the member’s eligibility is active

* You cannot use Authorization Manager for members who belong to a New England Blue Cross Blue Shield plan and have an out-of-state primary care provider.

Authorization Manager does not impact referral transactions in other eTools.

Tips for member searches

When entering member information:

Omit the ID prefix unless your patient is in the Federal Employee Program (include the "R" for FEP members).
Spell the member’s name exactly as it appears on their ID card.
If your patient is a twin, you must search for them using the suffix.
If you enter a suffix (01, 02, 03, etc.) that does not result in the intended member, try another search with a different suffix.

Tips for searching by the member suffix (Commercial):

Subscribers will be 00
Spouses are 01, 02, 03 (depending on how many spouses were listed under a specific policy)
Dependents will start with 10 then increase as dependents are added: 11, 12, 13, etc.

Tips for searching by the member suffix (FEP):

FEP suffixes start at 01, not 00 like Commercial
Unlike Commercial, FEP suffixes do not necessarily determine the member relation (subscriber, spouse, dependent)

Reminder: Newborn babies will not appear in Authorization Manager until the subscriber adds them to their plan.

Exceptions (such as when to fax your request)

Please fax your request to us in these situations:

Federal Employee Program members with out-of-state plans. We need to manually enter these members into our system.
Any updates to an authorization, such as date of service or level of care changes. You can use our Updates to Existing Authorizations form to submit these changes.
These medical requests:
- Transplants
- Cross-border referrals to a provider who is NOT contracted with Blue Cross Blue Shield of Massachusetts.
  Note: non-participating and cross-border authorization requests (such as for outpatient rehabilitation) must be submitted in Authorization Manager. Use "Service Request" as the request type.
- Out-of-network requests for the following services:
  - Specialist Referrals
  - Speech Therapy
  - Home care
  - Nutritional Counseling
- Endovenous Laser Therapy (EVLT) status
- FEP Advanced Benefit Determination for services that do not require an authorization
- Individual Consideration requests (see below)
These behavioral health services:
- Urine drug testing
- Out-of-network psychotherapy

Guides and video demonstrations

Guides (PDFs)

Topic	Guide or Quick Tip
General	Authorization Manager User Guide List of required CPT and HCPCS codes Using a code on this list will help ensure that your request is processed accurately.
PCP outpatient service requests	Outpatient rehabilitation
PCP outpatient specialist referrals	Specialist referrals
Medical inpatient requests	Emergency and elective inpatient requests (including transplants, gender affirming surgery, and biologics such as gene therapy) Inpatient musculoskeletal services (spine and joint) Skilled nursing facility, rehabilitation hospital, and Long Term Acute Care (LTAC/LTCH) hospital
Medical services (outpatient requests)	Ambulance services Fertility Services/Assisted Reproductive Technology (ART) Medication authorizations for commercial and Medicare Advantage Medication authorizations for Federal Employee Program (FEP) Outpatient musculoskeletal services (spine, joint, and pain management) Surgical Day Care and Durable Medical Equipment (DME)
Mental health inpatient requests	Behavioral Health Acute Inpatient Behavioral Health Inpatient Zulresso BH Residential and Community-based Acute Treatment (ART, CBAT, Subacute)
Mental health outpatient requests	Ambulatory Detox Applied Behavior Analysis (ABA) Esketamine Nasal Spray (Spravato^TM) & Intravenous Ketamine Family Stabilization (FST) Intensive Community Based Treatment (ICBT) Intensive Outpatient Program (IOP) Neuropsychological and psychological testing Partial Hospitalization (PHP) Repetitive Transcranial Magnetic Stimulation (rTMS)
Oral Surgery authorizations for Medical Members	Oral Surgery

Video demonstrations

Topic	Video
General	Searching for members (3 min) Submitting specialist referrals (4 min) Attaching clinical to an existing case (2 min) Accessing case details and printing correspondence (1 min)
Medical services: Inpatient	Adding a discharge date to an inpatient request (3 min) Emergent/urgent admission (3 min) Elective inpatient admission (3 min) Inpatient musculoskeletal services (spine and joint) (9 min) Skilled nursing facility, rehabilitation hospital, and Long Term Acute Care (LTAC/LTCH) hospital (3 min) Transplant precertification (4 min)
Medical services: Ambulance requests	Ground ambulance (4 min) Air ambulance (3 min) Chair car (3 min)
Medical services: Elective requests	Elective (outpatient) requests (3 min) Outpatient musculoskeletal services (spine and joint) (5 min) Pain management (8 min)
Medical services: Fertility Services/Assisted Reproductive Technology (ART)	Referrals for Early Pregnancy Monitoring (5 min) Fertility Services/Assisted Reproductive Technology (ART) Authorizations (6 min)
Medical services: Outpatient rehabilitation	Physical therapy outpatient rehabilitation (3 min) Occupational therapy outpatient rehabilitation (3 min) Speech therapy outpatient rehabilitation (4 min)
Mental health services: Outpatient	Ambulatory Detox (2 min) Applied Behavior Analysis (7 min) Esketamine and Ketamine (6 min) Family stabilization (2 min) Intensive Community Based Therapy (ICBT) (3 min) Intensive Outpatient Program: Alcohol/Substance use (2 min) Intensive Outpatient Program: Psychiatric/Eating disorder (2 min) Neuropsychological Testing (5 min) Partial Hospitalization Program: Alcohol/Substance use (2 min) Partial Hospitalization Program: Psychiatric/Eating disorder (2 min) Psychological Testing (5 min) Repetitive Transcranial Magnetic Stimulation (8 min)
Mental health services: Inpatient	Adding a discharge date to an inpatient request (3 min) Acute Residential Treatment (ART) and Community-Based Acute Treatment (CBAT): psychiatric/eating disorder (3 min) Acute Residential Treatment (ART) and Community-Based Acute Treatment (CBAT): subacute detox (2 min) Crisis stabilization (3 min) Inpatient psychiatric/eating disorder (2 min) Inpatient substance/detox (2 min) Zulresso (3 min)

News articles with additional tips

March 31, 2023: Attention ABA providers: Here’s how to use Authorization Manager
May 1, 2023: Authorization Manager tips for mental health providers
May 10, 2023: Helpful Authorization Manager tips
May 15, 2023: Authorization Manager tips for ART providers
June 1, 2023: We’ve simplified our ABA authorization response process
November 2, 2023: More helpful ABA reminders for Authorization Manager
April 30, 2024: How to avoid common Authorization Manager musculoskeletal errors
July 29, 2024: Questions about Auth Manager or InterQual? We can help!
September 24, 2024: Reminder: Submit level of care change requests via fax
March 5, 2025: Choosing the correct address in Authorization Manager
May 12, 2025: Frequency reminders for epidural steroid injections

Individual Consideration and other determinations

If you need an Organizational Determination, Advanced Benefit Determination, or Individual Consideration, please fax us at the appropriate number listed below:

For a member belonging to this plan	Fax your request to:
Commercial HMO, PPO, POS, and Indemnity	Fax 1-888-282-0780
Medicare Advantage HMO and PPO	Fax 1-800-447-2994
Federal Employee Program (FEP)	Contact your local plan. In Massachusetts, fax 1-888–282–1315

If you are contracted with Blue Cross Blue Shield of Massachusetts and have any questions about Authorization Manager, please contact us at hmmauthorizationmanager@bcbsma.com.
For clinical inquiries on InterQual^® for musculoskeletal requests, email us at MSKInterqual@bcbsma.com.
To contact us regarding an authorization request, please use the appropriate fax or phone number on our Prior Authorization Overview page.

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