Prescription Drug Prior Authorization Request

Start a new request by clicking the Start New Request button. Once you have completed and submitted the request, Blue Cross & Blue Shield of Mississippi will communicate with you by email if we need more information. You can start the process by providing the following required information.
Non-Network Provider Opioid Prior Authorization Request How-to Guide

All fields indicated with an asterisk(*) are required for submission.

*Prescribing NPI

Choose a Provider

Patient Information

*BCBSMS Subscriber ID *Subscriber's ZIP Code: *Patient's Last Name: *Patient's Date of Birth:

Prescription Drug Prior Authorization Request

Step 1: Find a Medication

	Enter drug name, or partial drug name, and click Search to find the matching medication(s) requiring prior authorization.

	Drug Name:

Step 2: Select a Prior Authorization Request Form

All fields indicated with an asterisk(*) are required for submission.

Patient Information

Attention