Authorization Manager

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To use this tool, simply log in, click on this page in the eTools tab, and look for the Go Now button. No additional username or password is necessary. Not registered for Provider Central? Find out who can register.

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Key features

You can enter and verify referrals in Authorization Manager. Learn more about referrals.

For authorization requests, Authorization Manager offers the comprehensive feature set shown below.

	Useful search tools Search member-specific authorization requirements by code Search by provider number to look up multiple patients at the same time
	Easy request submission Submit requests for mental health, medical, or surgical services (excluding oral surgery) Upload documentation to support clinical review
	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 AIM Specialty Health and WholeHealth Networks (Tivity)
	Automatic approvals Receive automatic authorization for 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.

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

When to call or fax your request

Please call or fax your request to us in these situations:

Twins and multiple births. At this time, Authorization Manager will not return eligibility if the patient has a sibling with the same birth date.
Federal Employee Program members with out-of-state plans. We need to manually enter these members into our system.

Guides and video demonstrations

Guides (PDFs)

Topic	Guide or Quick Tip
Multiple services	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 rehab and home health care for managed care members
PCP outpatient specialist referrals	Specialist referrals
Medical inpatient requests	Emergency and Elective Inpatient Requests (including Smartsheets, transplants, gender affirming surgery, and biologics such as gene therapy) 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 PPO home health care requests for home health care providers Surgical Day Care and Durable Medical Equipment (DME)
Mental health inpatient requests	Inpatient mental health services
Mental health outpatient requests	Outpatient mental health services Applied Behavior Analysis (ABA) Neuropsychological and psychological testing
Oral Surgery authorizations for Medical Members	Oral Surgery

Video demonstrations

Request type	Video
Referrals	How to submit a specialist referral (4 min)
All authorizations	Attaching clinical to an existing case (2 min) Accessing case details and printing correspondence (1 min)
Medical services: Inpatient	Emergent/urgent admission (3 min) Elective inpatient admission (3 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)
Medical services: Fertility Services/Assisted Reproductive Technology (ART)	Referrals for Early Pregnancy Monitoring (3 min)
Medical services: Outpatient rehabilitation and home health care	Home health care global - HMO/POS (3 min) Home health care initial - PPO (3 min) 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) 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) Partial Hospitalization Program: Alcohol/Substance use (2 min) Partial Hospitalization Program: Psychiatric/Eating disorder (2 min)
Mental health services: Inpatient	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) Inpatient ECT (2 min) Zulresso (3 min)

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.
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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