BlueCard Prior Authorization/Medical Policies

{"submission":{"method":"get","action":"https://apps.bcbs.com/cgi-bin/prefix_finder1.cgi","format":"encodedQueryString","target":"_blank","redirect":true,"beforeSubmit":[{"statement":"model.prefix = model.prefix.toUpperCase()"}]},"model":{"type":"object","properties":{"page_0":{"type":"string","value":"page1","omit":"true"},"disclaimer":{"type":"string","value":"No"},"policyType":{"type":"string","enum":[{"text":"Medical Policy","value":"medicalPolicy"},{"text":"General Precertification/Preauthorization Information","value":"generalPre-cert"}],"validation":{"required":true}},"prefix":{"type":"string","validation":{"required":true}}}},"form":[{"type":"page","name":"page1","items":[{"type":"heading","title":"Type of Information","level":"3"},{"type":"paragraph","items":["Please select only one."]},{"type":"radio-group","model":"policyType","stacked":true},{"type":"input","title":"Alpha Prefix","model":"prefix","width":"5","alignSelf":"start"},{"type":"button","title":"Submit","submit":true,"variant":"primary"},{"type":"paragraph","items":["If you experience difficulties or need additional information, please contact 800-676-BLUE."]}],"model":"page_0"}],"config":{"dndEditing":true}}
Complementary Content
${loading}