BCBS AFFILIATEFLPBM: Prime Therapeutics
Florida Blue (BCBS Florida) Prior Authorization Guide
Submit prior authorization requests and appeal denials with Florida Blue. Phone numbers, fax numbers, appeal deadlines, step therapy override rights, and clinical documentation tips for FL providers.
Prior Authorization Contacts
PA PHONE
1-800-955-5692
PA FAX
1-904-565-6637
TURNAROUND
15 days standard, 72h expedited
TIMELY FILING
180 days
APPEALS MAILING ADDRESS
Florida Blue, Attn: Member Appeals, PO Box 44232, Jacksonville, FL 32231
Common Denial Reasons
- ⚠ Florida Blue Medical Policy criteria not met
- ⚠ Step therapy required
- ⚠ Non-preferred formulary status
- ⚠ Site of care restrictions
Step Therapy Requirements & Override Rights
Florida HB 459 (2020) requires step therapy override provisions. Florida Blue must respond within 72 hours for urgent requests. For biologics, typically requires 2 DMARDs in RA, phototherapy + 1 systemic in psoriasis.
Tips for Florida Blue Submissions
- 1. Florida HB 459 protects against unreasonable step therapy
- 2. Submit via Availity
- 3. Prime Therapeutics is the PBM
- 4. Reference Florida Blue Medical Policy number
External Review Authority
If Florida Blue denies your final internal appeal, you have the right to request an external review through: Florida Office of Insurance Regulation.
External review decisions are binding on the insurer.