Prior Authorization for Mental Health and Substance Abuse
Please start the request by providing the following provider and patient information. 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 or when we reach a decision on your request.
All fields indicated with an asterisk(*) are required for submission.
The Provider ID you have entered is identified as a Network Provider. Network Providers must issue prior authorization requests through myBlue Provider (http://www.myaccessblue.com).
Provider Information
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Servicing Provider NPI
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Billing NPI
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Mental Health & Substance Abuse
Inpatient
Outpatient
Partial Hospitalization
Intensive Outpatient
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Admission Date(mm/dd/yyyy)
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Requested Dates of Service(mm/dd/yyyy):
From:
To:
Patient Information
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BCBSMS Subscriber ID
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Subscriber's ZIP Code
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Patient's Last Name
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Patient's Date of Birth