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Pre-service review for BlueCard members

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.

With the Blue Cross Blue Shield Plans’ Electronic Provider Access (EPA) router tool, you can access other Blue Plan’s provider portals to conduct pre-service reviews for BlueCard members.

The term pre-service review refers to:
  • pre-notification
  • precertification
  • pre-authorization
  • prior approval
  • other pre-claim processes

By entering the member’s three-character prefix from the ID card into this router, you will be automatically routed to their Blue Plan’s EPA landing page. Their page will connect you to the available electronic pre-service review processes that the Blue Plan offers.

Blue Plan landing pages look similar to one another but are customized based on the particular electronic pre-service review services that they offer.

The following are scenarios you can expect once routed to the member's plan:

Scenario 1

Real-time pre-service review is available for the service you are seeking. The member's plan will review or deny the request in real-time.

Scenario 2

Pre-service review is available, but the response will not occur in real time. After you enter the necessary information, the member's plan will provide an automated response that the pre-service review has been pended. The response will also share how the results will be communicated to you—usually via email, phone or fax. Note: Not all Blue Plans provide pre-service review 24 hours a day.

Scenario 3

The other plan's landing page lists instructions for how to conduct pre-service review for services that don’t have an electronic pre-service review option. In this situation, most Blue Plans list a direct phone number or provide a form you can download and fax.