Pre-Certification

The information presented here applies to most Blue Cross & Blue Shield of Mississippi Members, but there may be some differences based on each individual's health and wellness benefit plan. Members can access their benefit plan through the myBlue portal on www.bcbsms.com. Some forms below can be submitted online. Others are PDF documents in which you can enter the information, save it on your computer, print and fax the form according to the instructions. This page is separated into Medical Services and Prescription Medications.

Medical Services

Providers who need assistance may call these numbers between 8:00 a.m. and 4:30 p.m. central time, Monday through Friday.

Provider Service: 601-932-1122 or 1-800-257-5825
Utilization Management: 601-664-4597 or 1-800-841-9659

Forms

Outpatient and Professional Services
Durable Medical Equipment
Inpatient Services
Home Health & Hospice Care
Home Infusion Therapy
Medical Transport
Mental Health and Substance Abuse [online form]
Solid Organ and Tissue Transplant
Treating Tobacco Use and Dependence Instructions

Maternity - If a maternity stay is expected to extend beyond 48 hours for vaginal delivery or 96 hours for caesarian section delivery, the Physician must request the additional days in order for the Company to determine the Medical Necessity. The Inpatient Medical-Surgical Services form may be used.

Hospice benefits require a Network Physician’s life expectancy certification

Solid Organ and Tissue Transplant require precertification. Please contact us at the phone numbers above.

Prescription Medications

Providers with questions should contact the Prescription Drug Service Team by phone at 601-664-4998 or 1-800-551-5258, 8:00 a.m. to 4:30 p.m. central time, Monday through Friday.

Prescription Drug benefits can vary depending on your patient's benefit plan. Members' financial responsibility may be either a co-payment or co-insurance amount. Members should refer to their Benefit Plan for their specific out-of-pocket expense responsibility. Certain drugs must be prior authorized by Blue Cross & Blue Shield of Mississippi, and dispensed by a Network Provider to be covered.

*Certain Growth Hormone Disease Specific Drugs are subject to a closed formulary based upon your patient's health benefit plan.

**Prior Authorizations are required for all new high-dosage Crestor (20mg and 40mg) prescriptions that are prescribed by primary care providers. This requirement does not apply, at this time, to Cardiologists and Endocrinologists.

***Generic First Program applies.

Physicians are responsible for submitting a prior authorization request directly to Blue Cross & Blue Shield of Mississippi for approval.

Click here to begin a Prescription Drug Prior Authorization Request

Medications requiring Prior Authorization
A-E
Abilify*** Apokyn Cimzia
Actemra Arcalyst Copaxone
Actimmune Aralast Copegus
Actiq Avita Crestor 20mg**
Adagen Avonex Crestor 40mg**
Adcirca Bebulin Differin
Advate Benefix Dysport
Aldurazyme Betaseron Elaprase
Alphanate Botox Elelyso
Alphanine Carimune Enbrel
Anabolic Steriods Celebrex 400mg Epoprostenol Sodium
Androgenic Steroids Ceredase Exjade
Amevive Cerezyme Extavia
Ampyra Chorionic Gonadotropins Eylea
Ampyra Chorionic Gonadotropins  
Apokyn Cimzia  
F-M
Fabrazyme Gilenya Koate-DVI
Feiba VH Hexilate FS Kogenate FS
Fentora Hemofil M Krystexxa
Firazyr Hizentra Letairis
Flebogamma Humate-P Lucentis
Flolan (Epoprostenol) *Humatrope Lupron
Gamastan S/D Humira Macugen
Gammagard Incivek Monarc-M
Gammagard Liquid Increlex Monoclate-P
Gammaked Infergen Mononine
Gammaplex Intron-A Myobloc
Gamunex Kalydeco  
*Genotropin Kineret  
N-R
Naglazyme Peg-Intron Remodulin
*Norditropin Privigen Retisert
Novoseven Profilnine SD Retin-A
*Nutropin Progesterone Gels Revatio
Octagam Proplex T Ribapak
*Omnitrope Provenge Ribasphere
Onfi Rebetol Ribavirin
Onsolis Rebif Rituxan
Orencia Recombinate Roferon-A
Orfadin Refacto  
Pegasys Remicade  
S-Z
*Saizen *Tev-Tropin Xiaflex
*Serostim Tracleer Xolair
Seroquel XR*** Tysabri Xyntha
Simponi Tyvaso Zelboraf
Somavert Ventavis Zemaira
Stelara Victrelis Zoladex
Suboxone Vivaglobin *Zorbtive
Subutex Vpriv  
Synagis Wilate