How to Fill Out and Submit the BCBS Louisiana Prior Authorization Form

The BCBS Louisiana prior authorization form is the PDF that a provider’s office completes and sends to Blue Cross and Blue Shield of Louisiana to get approval before performing certain inpatient, outpatient, or office-based services. Once it’s filled out with the patient’s information, the diagnosis and procedure codes, and supporting clinical records, the form goes to BCBS LA by fax at 1-800-586-2299, electronically through the iLinkBlue portal, or by phone at 1-800-523-6435. Louisiana law then requires the insurer to return a decision within five business days for standard requests.¹

One boundary to know before you start: this form is for services reviewed directly by the BCBS LA Authorization Department. It’s not the right form for services handled by third-party vendors like Express Scripts, Carelon, or EviCore, which have their own submission paths.² Pharmacy drugs and physician-administered medical drugs are covered further down.

Confirm the Service Actually Needs Authorization

There is no universal list of services that always require pre-approval, because authorization rules vary by the member’s benefit plan. Before filling anything out, verify the specific member’s eligibility, benefits, and limitations through iLinkBlue.³ Members on self-funded employer plans may have extra authorization requirements beyond the standard fully insured rules; those members should ask their employer or plan administrator for the plan-specific list.⁴

What to Gather Before You Fill It Out

Most rejections aren’t about medical judgment. They’re about missing or mismatched information. Pulling everything together in advance keeps the request moving.

Member details. The patient’s full name, date of birth, and identification number exactly as printed on the BCBS LA insurance card. A single transposed digit in the member ID can trigger an administrative rejection that has nothing to do with medical appropriateness.
Provider details. The ordering provider’s name, practice address, phone number, fax number, and National Provider Identifier (NPI). Include the facility or servicing provider’s information as well, if different from the ordering provider.
Diagnosis codes. ICD-10 codes describing the patient’s condition and the clinical reason for the request.
Procedure codes. The CPT or HCPCS codes for the specific service, procedure, or equipment, plus number of units and the proposed dates of service.
Clinical documentation. Recent office notes, lab results, imaging reports, or other records that support medical necessity.

Downloading and Completing the Form

The authorization form is a downloadable PDF on the BCBS LA provider website at providers.lablue.com, under electronic services or the forms library. BCBS LA updates it periodically, so pull a fresh copy for each request rather than reusing an older file.⁵

The form is divided into sections. The top portion captures patient demographics and insurance information. The middle section is for clinical details: diagnosis codes, procedure codes, dates of service, and the clinical rationale. If you’re a patient reviewing the form before your provider sends it out, check that your name, date of birth, and member ID match your insurance card exactly.

Match the clinical documentation to what the form is asking. If the form asks for the reason a service is needed, the attached notes should speak directly to that reason rather than dumping the patient’s entire chart. Reviewers at BCBS LA are nurses applying defined clinical criteria, and a clear line from diagnosis to proposed treatment to supporting evidence reduces the odds of a request for additional information.³

Whether you’re submitting a new request or an extension, the form has to reach BCBS LA before the service is performed. Services delivered without proper authorization may be subject to penalties.⁵

How to Submit the Form

BCBS LA accepts three submission channels for standard medical service authorizations. Electronic submission through iLinkBlue is the fastest and most reliable.

iLinkBlue

The iLinkBlue portal at ilinkblue.lablue.com hosts several authorization applications, each covering a different service type, and is available around the clock. Each application requires user-level security access assigned by your organization’s iLinkBlue administrative representative.³

For inpatient and outpatient services, use “Louisiana Blue Authorizations” for BCBS LA members, “Pre-Service Review for Out-of-Area Members” for BlueCard members from other Blue plans, or “Blue Advantage Provider Portal” for Blue Advantage (Medicare Advantage) members.
For behavioral health services, use “Behavioral Health Authorizations.”
For diagnostic imaging, use “Carelon Authorizations.”

The portal lets you upload supporting clinical documents and generates a tracking number for each submission.

Fax

Fax the completed form and all supporting clinical records to 1-800-586-2299.⁶ Keep the transmission confirmation as proof of delivery, and make sure every page is legible. Blurry or cut-off pages are a common cause of delay.

Phone

You can also call the BCBS LA Authorization Department at 1-800-523-6435 to initiate or discuss a request.⁶

Pharmacy Drugs and Medical Drugs Go Elsewhere

Prescription drug prior authorizations don’t use the standard BCBS LA form. They go through Express Scripts, the pharmacy benefit manager, either by faxing the Drug Authorization Form to 1-877-251-5896 or by calling Express Scripts at 1-800-842-2015. Targeted medications, Step Therapy overrides, and formulary exception requests all use the same contact information.⁷

Physician-administered drugs (infusions, injections given in a provider’s office, and similar medications delivered in a medical setting) follow a separate path. Since December 2024, providers submit these medical drug authorizations through the EviCore provider portal at www.evicore.com rather than through iLinkBlue.⁸

If your office doesn’t have an EviCore account, register at www.evicore.com by clicking “Register Now” below the portal login, selecting “CareCore National” as the default web portal, and completing the registration form. Requests submitted online typically process in about half the time of phone-based submissions. For technical help, call 1-800-646-0418 (option 2) or email portal.support@evicore.com, Monday through Friday, 6 a.m. to 6 p.m. Central. Federal Employee Program (FEP) authorizations should not go through the EviCore portal.⁸

How Long the Review Takes

Louisiana law sets firm decision deadlines under Louisiana Revised Statutes 22:1260.44.¹

Standard requests: a decision within five business days of receipt. If BCBS LA asks for more information, the clock resets and it has another five business days from when the additional information arrives.
Urgent or expedited requests: the insurer must offer an expedited electronic review and decide within two business days, or within 48 hours after receiving any additional information it requests.
Concurrent review for extending an ongoing hospital stay or adding services during treatment: a decision within 24 hours of receiving the necessary information.

BCBS LA’s own authorization guide states a turnaround of three to five business days for non-urgent requests, which fits within the statutory ceiling.⁹ Once a determination is made, the insurer must notify the provider by phone or electronically within 24 hours and send written confirmation to both provider and member within three business days.¹

If the Request Is Denied

A denial isn’t final. BCBS LA offers both informal and formal paths to challenge a decision, and the two run on very different timelines.

Informal Reconsideration

For denials based on medical necessity, the ordering provider can request a phone conversation with a BCBS LA Medical Director or peer reviewer. This is the fastest route. It must be requested within 10 days of the denial, and BCBS LA conducts the review within one working day of receiving the request. The conversation often centers on additional clinical information or a direct peer-to-peer discussion. This step is available only for initial or concurrent review denials.¹⁰

Formal Appeal

A formal appeal is a written request asking BCBS LA to reverse its decision. It covers denied authorizations, denied claims, and medical necessity determinations. BCBS LA posts a downloadable appeal request form on its website; submitting it with supporting documentation gives the review team the clearest picture. To start, call the Customer Service number on the back of the member ID card for plan-specific instructions. Hearing-impaired members can reach BCBS LA through the Louisiana Relay Service at 1-800-846-5277 (TTY), providing 1-800-599-2583 as the number to reach BCBS LA.¹⁰

If the first appeal is unsuccessful, additional levels of internal appeal may be available under the specific policy, contract, or applicable law. Check the plan documents or ask customer service what further internal review options exist.

External Review

Once internal appeals are exhausted, federal law gives the member the right to an independent external review for denials involving medical judgment or a determination that a treatment is experimental. The filing deadline is four months from the date of the final internal appeal decision. An independent review organization, not BCBS LA, decides the case, and its decision is binding: 45 days for standard reviews, 72 hours for urgent ones. External review fees are capped at $25, and the HHS-administered federal process is free. Requests can be filed online at externalappeal.cms.gov, by fax at 1-888-866-6190, or by mail to MAXIMUS Federal Services, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534.¹¹

1
Louisiana State Legislature. Louisiana Revised Statutes 22 1260.44 – Timeframes for Determinations
2
Blue Cross and Blue Shield of Louisiana. Authorization Form
3
Blue Cross and Blue Shield of Louisiana. Authorizations
4
Blue Cross and Blue Shield of Louisiana. Prior Authorizations
5
Blue Cross and Blue Shield of Louisiana. Authorization Form
6
Blue Cross and Blue Shield of Louisiana. Professional Provider Office Manual – Reference Section
7
Blue Cross and Blue Shield of Louisiana. Pharmacy
8
Blue Cross and Blue Shield of Louisiana. Electronic Submission Portal Change for Medical Drug Authorizations FAQs
9
Blue Cross and Blue Shield of Louisiana. Inpatient/Outpatient Authorization Guide
10
Blue Cross and Blue Shield of Louisiana. Appeals and Grievances
11
HealthCare.gov. External Review