BlueCard®: Electronic Provider Access

Policy Number: GP-X-084

Last Updated: Sept. 1, 2022 

Electronic Provider Access (EPA) gives providers the ability to access an out-of-area member’s Blue Cross and Blue Shield (BCBS) Plan provider portals to conduct electronic pre-service reviews. The term pre-service review refers to pre-notification, pre-certification, preauthorization and prior approval, amongst other pre-claim processes. EPA enables providers to use their local BCBS Plan’s provider portal to access an out-of-area member’s BCBS Plan provider portal, through a secure routing mechanism. Once in the member’s BCBS Plan provider portal, the out-of-area provider has the same access to electronic pre-service review capabilities as the Plan’s local providers. 

The availability of EPA varies depending on the capabilities of each BCBS Plan. Some Plans have electronic pre-service reviews for many services, while others do not. The following describes how to use EPA and what to expect when attempting to contact BCBS Plans. 

Using the EPA Tool 

The first step for providers is to go to NaviNet and log in. Select the menu option: Pre-Service Review for Out-of-Area Members (includes notification, pre-certification, preauthorization and prior approval). 

Next, select the provider and the prefix from the member’s ID card. The prefix is the first three characters that precede the member ID card. 

Entering the member’s prefix from the ID card automatically routes you to the BCBS Plan’s EPA landing page. The landing page allows you to connect to the available electronic pre-service review processes. Because the screens and functionality of Plans’ pre-service review processes vary widely, Plans may include instructional documents or e-learning tools on the landing page to provide instruction on conducting an electronic pre-service review. The page also includes instructions for conducting pre-service review for services where the electronic function is not available. 

The BCBS Plan landing page looks similar across Plans but will be customized to the particular Plan based on the electronic pre-service review services they offer. 

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