Blue Cross Blue Shield Association Letter of Medical Necessity Guide
How to write an LMN and overturn a prior authorization denial with Blue Cross Blue Shield Association. Includes denial reasons, turnaround times, appeals address, and clinician tips.
Quick Facts
- Avg Turnaround: 30 days standard, 72h expedited
- Appeals Address: Varies by local Blue plan
- Provider Portal: https://www.bcbs.com/
Why BCBS Denies Prior Authorizations
- 1. Plan-specific medical policy
- 2. Step therapy
- 3. Site of care
- 4. Investigational
Clinician Tips for BCBS
- ✓ Identify local Blue plan (Anthem, Highmark, Horizon, etc.) — policies differ
- ✓ Cite local medical policy number
- ✓ Use BlueCard for out-of-state members
BCBS is a federation — 33 independent plans each with their own policies. Always identify the specific plan.
BCBS Prior Authorization FAQ
Why does BCBS deny prior authorizations?
The most common BCBS denial reasons are: Plan-specific medical policy; Step therapy; Site of care; Investigational.
How long does BCBS take to review a prior authorization?
BCBS typically responds in 30 days standard, 72h expedited.
What should a Letter of Medical Necessity for BCBS include?
An LMN for Blue Cross Blue Shield Association should reference the specific medical policy or coverage bulletin, document failed first-line therapies with dates, include current labs and ICD-10 codes, and cite supporting clinical guidelines. BCBS is a federation — 33 independent plans each with their own policies. Always identify the specific plan.