You can use the Pre-Service Review tool to request authorization for BlueCard members.
Log in and visit our eTool page, Pre-service review for BlueCard members.
For all other members, please continue using Authorization Manager.
You can use the Pre-Service Review tool to request authorization for BlueCard members.
Visit our Pre-service review for BlueCard members page and click Go Now.
For all other members, please continue using Authorization Manager.
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.
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Useful search tools
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Easy request submission
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Flexible status verification
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Automatic approvals
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* 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.
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.
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
- Referrals to non-participating specialists/cross-border referrals. Note: non-participating and cross-border outpatient rehabilitation authorization requests may be submitted in Authorization Manager. Use "Service Request" as the request type.
- Endovenous Laser Therapy (EVLT) status
- Interoperative Neurological (spine) Monitoring (IONM)
- Gene Therapy and Car-T Cell requests
- FEP Advanced Benefit Determination
- Individual Consideration requests (see below)
- These behavioral health services:
- Urine drug testing
- Out-of-network psychotherapy
For subscribers employed by Steward Health Care, any requests for tier exceptions for them or their dependents must be submitted directly to Steward's Health Care Coordination Department.
- 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
- January 13, 2025: Avoid delays for Auth Manager musculoskeletal requests
- March 5, 2025: Choosing the correct address in Authorization Manager
- May 12, 2025: Frequency reminders for epidural steroid injections
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.
This eTool allows you to quickly access authorization information for Blue Cross Blue Shield of Massachusetts members. It can be used by any provider rendering services to a Massachusetts member. (Federal Employee Program members may not be included.)
With this tool, you can:
- Find out if an authorization is required. Enter a procedure and diagnosis code (and a few other pieces of information) to see if authorization is required for an outpatient medical or behavioral health service, surgical service, or provider-administered medication.
- Check the status of a referral or authorization.
For our network providers
Authorization Quick Lookup doesn't replace Authorization Manager. It serves as a fast and easy alternative way to get information. Continue using Authorization Manager or any of our other eTools to enter authorization requests and to check on the status of referrals and authorizations. With Authorization Manager, you have full access to authorization information.
If an authorization is not required, you can make a note of the inquiry number returned in your results. To access the record in the future, you can use the "View Inquiry" feature in Authorization Manager.
Our vendor, Carelon Medical Benefits Management, administers prior authorization programs for us in the areas listed below. Use Carelon’s secure website to submit prior authorization requests for these services that our members may need.
Click the links to access more information about these programs, including services that need prior authorization and members included in the program.
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.
Use the Rapid Response System to submit chiropractic services authorization requests to our vendor, WholeHealth Living, Inc., a Tivity Health company.
Learn more
Get information about the authorization requirements, including which members are required to have a medical necessity review for chiropractic services.
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.
Clear Claim Connection uses editing software to process professional and outpatient facility claims for all of our products. With this tool, you can:
- View code editing rationale
- Identify and correct common coding occurrences
Codes not found in Clear Claim Connection or our medical policies
Get a list of physician claim code-to-code edits not included in Clear Claim Connection or our medical policies.
ConnectCenter is a tool medical and behavioral health providers can use to submit claims and to perform most real-time transactions. It is owned and maintained by Change Healthcare.
With ConnectCenter, you can:
- Check member benefits and eligibility
- Check the status of your claims
- Submit and verify referrals
- Submit and track professional 1500 claims and replacement claims using Direct Data Entry (DDE)
To request authorization or check the status of your authorization requests, use Authorization Manager. Note: You can learn authorization requirements in ConnectCenter. Refer to our Quick Start Guide for more information.
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.
Screenshots are available in the "Tips for Common Transactions" area below.
New to Provider Central?
Here are the answers to frequently asked questions.
Only contracted providers, their staff, and their billing agencies can register for Provider Central and use ConnectCenter. Learn more.
Log in, click eTools>ConnectCenter, and look for the Go Now button. No additional username or password is necessary.
If you are registering for Provider Central, please wait 15 minutes after creating your account before performing a real-time transaction in ConnectCenter. Please wait one business day before submitting a claim in ConnectCenter.
Non-participating providers can use the following resources.
- For benefits, eligibility, and prior authorization inquiries, call BlueCard® EligibilitySM at 1-800-676-BLUE (2583).
- For details about processed claims, use Payspan.
- For referral and authorization request submissions, use a tool or fax number on our Prior Authorization page. These resources also appear in our Authorization Quick Tip.
- To check eligibility, benefits, or claim status, you can also use our phone-based system, InfoDial. You can reach InfoDial at 1-800-443-6657.
Trainings and resources
| Getting started with ConnectCenter | |
| How to navigate in ConnectCenter (7 min) How to create a default provider (6 min) |
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| Eligibility | |
| How to create an eligibility request (5 min) How to use response information (3 min) How to use interactive response views (4 min) |
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| Referrals | |
| How to use referral screens (7 min) | |
| Claims | |
| How to create a claim (11 min) |
ConnectCenter Quick Start Guide
ConnectCenter Provider Management Quick Tip
ConnectCenter Claims Quick Tip
Checking Claim Status Quick Tip (includes Payspan)
ConnectCenter best practices
Save yourself keystrokes by setting up records in the Provider Management area. Then, set a default Requesting Provider (for real-time transactions). If you will use ConnectCenter to submit claims, set defaults for Billing Provider and Rendering Provider as well.
Instructions are in the Provider Management Quick Tip.
Most ConnectCenter screens include sections that can be expanded or collapsed ("accordions"). It is helpful to collapse the sections you don't need.
As the example below indicates, inquiry responses appear under the Submit button and may include drop-down menus for changing the information displayed.
If you submit claims through ConnectCenter, the tool will automatically create Worklists of denied claims, rejected claims, and incomplete claims. When you resolve the problem with a claim, you can delete it from your Worklist.
Tip: You can use claims in your Incomplete Claims Worklist as templates. Learn more in our Quick Start Guide.
When you have finished performing transactions in ConnectCenter, be sure to log out to protect Personal Health Information available through the tool. Users who do not log out may find that their sessions eventually time out automatically. Simply close the Change Healthcare window and log into Provider Central again to begin a new session.
Tips for common transactions
Notes:
- You can also submit referrals using Authorization Manager. To compare the eTools, visit our Entering and Verifying Referrals page.
- Reminder: Submit an authorization request—not a referral—for outpatient rehab (PT/OT). Use Authorization Manager for these services.
- You can save keystrokes by starting with an eligibility inquiry. In the Demographic Information row of your results, open the Select Transaction drop-down menu and select a transaction. Then click the button, Use Member For.
For Type, you will usually enter "Visits." Place of Service codes can be found here.
ConnectCenter is a tool medical and behavioral health providers can use to submit claims and to perform most real-time transactions. It is owned and maintained by Change Healthcare.
With ConnectCenter, you can:
- Check member benefits and eligibility
- Check the status of your claims
- Submit and verify referrals
- Submit and track professional 1500 claims and replacement claims using Direct Data Entry (DDE)
To request authorization or check the status of your authorization requests, use Authorization Manager. Note: You can learn authorization requirements in ConnectCenter. Refer to our Quick Start Guide for more information.
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.
Screenshots are available in the "Tips for Common Transactions" area below.
New to Provider Central?
Here are the answers to frequently asked questions.
Only contracted providers, their staff, and their billing agencies can register for Provider Central and use ConnectCenter. Learn more.
Log in, click eTools>ConnectCenter, and look for the Go Now button. No additional username or password is necessary.
If you are registering for Provider Central, please wait 15 minutes after creating your account before performing a real-time transaction in ConnectCenter. Please wait one business day before submitting a claim in ConnectCenter.
Non-participating providers can use the following resources.
- For benefits, eligibility, and prior authorization inquiries, call BlueCard® EligibilitySM at 1-800-676-BLUE (2583).
- For details about processed claims, use Payspan.
- For referral and authorization request submissions, use a tool or fax number on our Prior Authorization page. These resources also appear in our Authorization Quick Tip.
- To check eligibility, benefits, or claim status, you can also use our phone-based system, InfoDial. You can reach InfoDial at 1-800-443-6657.
Trainings and resources
| Getting started with ConnectCenter | |
| How to navigate in ConnectCenter (7 min) How to create a default provider (6 min) |
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| Eligibility | |
| How to create an eligibility request (5 min) How to use response information (3 min) How to use interactive response views (4 min) |
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| Referrals | |
| How to use referral screens (7 min) | |
| Claims | |
| How to create a claim (11 min) |
ConnectCenter Quick Start Guide
ConnectCenter Provider Management Quick Tip
ConnectCenter Claims Quick Tip
Checking Claim Status Quick Tip (includes Payspan)
ConnectCenter best practices
Save yourself keystrokes by setting up records in the Provider Management area. Then, set a default Requesting Provider (for real-time transactions). If you will use ConnectCenter to submit claims, set defaults for Billing Provider and Rendering Provider as well.
Instructions are in the Provider Management Quick Tip.
Most ConnectCenter screens include sections that can be expanded or collapsed ("accordions"). It is helpful to collapse the sections you don't need.
As the example below indicates, inquiry responses appear under the Submit button and may include drop-down menus for changing the information displayed.
If you submit claims through ConnectCenter, the tool will automatically create Worklists of denied claims, rejected claims, and incomplete claims. When you resolve the problem with a claim, you can delete it from your Worklist.
Tip: You can use claims in your Incomplete Claims Worklist as templates. Learn more in our Quick Start Guide.
When you have finished performing transactions in ConnectCenter, be sure to log out to protect Personal Health Information available through the tool. Users who do not log out may find that their sessions eventually time out automatically. Simply close the Change Healthcare window and log into Provider Central again to begin a new session.
Tips for common transactions
Notes:
- You can also submit referrals using Authorization Manager. To compare the eTools, visit our Entering and Verifying Referrals page.
- Reminder: Submit an authorization request—not a referral—for outpatient rehab (PT/OT). Use Authorization Manager for these services.
- You can save keystrokes by starting with an eligibility inquiry. In the Demographic Information row of your results, open the Select Transaction drop-down menu and select a transaction. Then click the button, Use Member For.
For Type, you will usually enter "Visits." Place of Service codes can be found here.
In the meantime, you can learn about alternative options to submit claims, request authorization and referrals, and to check eligibility and benefits.
In the meantime, you can learn about alternative options to submit claims, request authorization and referrals, and to check eligibility and benefits.
You can check dental eligibility and benefits at no cost using Dental Connect. With this eTool, you can:
- Verify member benefit and eligibility information online at your convenience
- Search by CDT code or keyword
- See frequency limitations that are part of a member’s benefit design (for example, D2750 Crown benefit is paid one time per 60 months)
- Check the last time a procedure was performed (For example, you can now find the specific date when your patient had their last full mouth series, D0210, which is covered once per 60 months)
- Verify the member's remaining deductible
How to get started
Go to Dental Connect. When registering, use partner code BCMA01DPS to enable Blue Cross Blue Shield of Massachusetts to sponsor monthly fees for this service for our members. National Dental Network dentists can use the tool too!
Learn more
ConnectCenter and DentalConnect issues
ConnectCenter and DentalConnect are unavailable due to the cybersecurity issue at Change Healthcare. Learn about alternative options to submit claims, request authorization and referrals, and to check eligibility and benefits.
Can you or your clearinghouse/billing service create and receive HIPAA-compliant 837 and 835 files? If so, you can connect your IT system to ours and use this direct connection—or electronic data interchange—to perform electronic transactions. We encourage all health care providers to submit transactions and receive payments electronically to benefit from:
- Reduced administrative costs and paperwork for your office
- Improved accuracy of billing and posting information
- Better security for protected information
- Improved cash flow
- Faster claims processing
- A dedicated EDI (Electronic Data Interchange) team available to assist help you
We can set up a direct connection with you for these transactions:
| EDI transaction | Description |
|---|---|
| 278 | Health care service review – Request for review and response |
| 835 | Claim payment advice (electronic remittance) |
| 837 | Health care claims |
| 270/271 | Eligibility and benefits |
| 276/277 | Claim status |
If you can create a HIPAA-compliant 837, follow these steps to start submitting transactions directly to Blue Cross Blue Shield of Massachusetts.
If you cannot create a HIPAA-compliant 837, please refer to the following section, "What to do if you use a clearinghouse."
Please note: You don't need to follow these steps if you are contracted with us and would like to submit professional claims using Direct Data Entry (DDE) via ConnectCenter.
Step  |
Email EDIsupport@bcbsma.com to request a Trading Partner Agreement (TPA) and SFTP Account Request Form.
In your email, please include your organization’s legal name and corporate mailing address. |
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Email us the completed forms. Use the subject line, "Security Forms." NOTE: If you are planning to have more than one user, have all the individuals at your organization who will need manual access to your Tumbleweed EDI mailbox complete the SFTP Account Request Form (sections in brackets). Email us separately.
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Test the system An EDI analyst will contact you to guide you through the testing process. |
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Begin submitting transactions After successfully testing and completing the required forms, you can begin submitting transactions directly to Blue Cross Blue Shield of Massachusetts. |
We have completed testing and have trading partner agreements in place with many of the major clearinghouses.
If you select and sign a contract with an approved clearinghouse, please have them email a completed EDI Enrollment Form to EDIsupport@bcbsma.com. (They have the form.)
Here’s a list of approved clearinghouses:
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These guides and resources can help you with your electronic transactions. Make sure you access the latest version of these guides. Revisions we make are noted on the last page of each document.
| Use this resource | To |
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| Learn specific data content for electronic transactions with Blue Cross Blue Shield of Massachusetts | |
| Access CAS, claim status and other codes lists. |
Contact our EDI Production Support team:
Email: EDISupport@bcbsma.com
Phone: 1-800-771-4097 (Available Monday-Friday, 8 a.m. - 4 p.m.)
Working with Payspan®, Inc., we offer secure electronic funds transfer (EFT), also known as direct deposit, of your organization’s payments for services.
Medical providers are required to be reimbursed by EFT. This includes physicians, clinicians, hospitals, and facilities. For dental providers, EFT is our standard method of payment.
What you can do with Payspan
- Receive your payments by secure EFT
- Verify the weekly status of your checks
- Access claim and payment data 24/7
- View, print, and search Provider Payment Advisories (PPAs) and Provider Detail Advisories (PDAs)
- Obtain Account Receivable information.
How to get started
| Step |
Request a registration code and PIN by going to payspanhealth.com/RequestRegCode/. Payspan will email you a registration code. |
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Go to Payspan, click Register
Now, and follow the prompts to create your account. You will need:
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A few days after you create your Payspan account, check your organization’s bank account to learn the exact amount of the small deposit made by Payspan®, Inc. |
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Log on to Payspan, enter the deposit amount, and click Confirm. Your account status will become “active” and Blue Cross’s systems will be updated within three business days. You must complete this step to finish your registration. |
For a 90-day period after you register for Payspan, you’ll get paper and electronic Provider Payment and Provider Detail Advisories. After that, you will only get them online through Payspan.
Learn more about Payspan
- Watch a 2-minute tutorial on researching your payment advisories
- View a sample medical or dental Provider Detail Advisory.
Support from Payspan, Inc.
- Call 1-877-331-7154
- Log on to Payspan and go to Help > News Articles.
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.
- pre-notification
- precertification
- pre-authorization
- prior approval
- other pre-claim processes
Note: You cannot use the EPA router tool for Federal Employee Program (FEP) members. For FEP, use Authorization Manager.
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.
TransactRx is a web-based tool offered by POC Technologies. Use this tool to submit Part D vaccine claims for Medicare Advantage members ONLY. TransactRx Vaccine Manager features:
- Easy online access to patient specific coverage
- Ability to get reimbursed for vaccines covered under Part D
- Real-time out-of-pocket (copay) cost and reimbursement information
- Electronic claims submission for vaccines covered under Part D
How to get started
Contact TransactRx at 1-866 522-3386. You will complete a one-time-only registration process and sign an agreement with POC.
