Referrals and prior authorizations
Some specialists — and specialty treatment centers (like nephrology or infusion) — may require a referral from your primary care doctor or prior authorization from Accolade before you can make an appointment. When scheduling an appointment, call Accolade at (866) 406-1182, Monday–Friday, 5 a.m.–8 p.m. PT to ask if a preservice review or precertification is required prior to your initial visit.
Certain services, such as a planned surgery with an overnight hospital stay, require prior authorization from Accolade. If you have a procedure scheduled or a condition that will require treatment, you may need a preservice review. For assistance, call Accolade at (866) 406-1182, Monday–Friday, 5 a.m.–8 p.m. PT.
Filing claims
Medical and behavioral health
When you see in-network providers, there are no claim forms to fill out. Your provider handles all the paperwork.
If you see an out-of-network provider for medical or behavioral health services or use an out-of-network pharmacy, it's up to you to submit a claim for reimbursement for services received or prescriptions.
The easiest way to file an out-of-network claim is to start with Accolade. Call (866) 406-1182 (Monday–Friday, 5 a.m.–8 p.m. PT) or visit the Accolade member portal. Accolade will direct you to the correct forms and answer any questions you have.
If you prefer, you can file out-of-network medical and behavioral health claims directly with Blue Shield of California.
Pharmacy
When you fill prescriptions at Navitus network pharmacies, there are no claim forms to fill out. Your pharmacy handles all the paperwork. If you use an out-of-network pharmacy, it's up to you to submit a claim for reimbursement for services received or prescriptions. The easiest way to file an out-of-network claim is through the Navitus member portal.