What is the Prior Authorization API?

The Prior Authorization API is a secure, standards-based interface that allows a provider to query Blue Cross and Blue Shield of North Carolina’s (Blue Cross NC) system to determine whether prior authorization (PA) is required for specific medical items and services (excluding drugs), as well as to view a list of all covered items and services for which Blue Cross NC requires prior authorization. In addition, the API identifies Blue Cross NC’s documentation requirements for the items or services that require prior authorization. The API also supports the creation and exchange of prior authorization requests from providers and responses from Blue Cross NC (including whether the request was approved or denied, and a specific reason for any such denial).