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We’ve provided the following resources to help you understand Anthem’s prior authorization process and obtain authorization for your patients when it’s required.
Access and download these helpful BCBSTX health care provider forms. Each medication plan comes with a list (or formulary) that shows you what medications are covered.You'll go to Prime Therapeutics, our pharmacy benefit manager's website. ?�������Ge�?��'� d� - ®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. ©1998-2020 BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association. You can also visit The resources on this page are specific to your state. endstream endobj 417 0 obj <>stream
*Requires prior authorization before being covered Sexual Dysfunction Drugs Related to Organic Disease (e.g., Cialis ®, Viagra ®, Caverject ®) Underwritten and Individual / Family plans: 4 tablets or units per 30 days All:
427 0 obj <>/Filter/FlateDecode/ID[<389A46ED9084714AB4C22E2528DD021B><58C13A4B2602F8469EE6C5769AC9B26A>]/Index[413 31]/Info 412 0 R/Length 83/Prev 86482/Root 414 0 R/Size 444/Type/XRef/W[1 3 1]>>stream This may mean taking fewer pills each day without changing the total strength of the medication.Blue Cross NC requires that patients first try a medication or device that is not restricted before a restricted medication will be approved. 1 Cameron Hill Circle, Chattanooga TN 37402-0001 An urgent request is when you believe a delay would seriously jeopardize the life or health of the patient, the patient's ability to regain maximum function, or would subject the patient to severe pain that cannot be adequately managed without the care or treatment requested.If you want your patient to take a medication that isn't on the Essential or Net Results medication list, here's what to do: Some medications may not be covered by the patient's plan or may have a limited amount the patient can receive.
A Radiology Quality Initiative (RQI) number is required by BCBSIL prior to ordering CT/CTA scans, MRI/MRA scans, Nuclear Cardiology studies, and PET scans for most PPO members. 413 0 obj <> endobj
Form Description; %PDF-1.5 %���� Prior Authorization Health insurance can be complicated—especially when it comes to prior authorization (also referred to as pre-approval, pre-authorization and pre-certification).
Your patient's medication list, or formulary, search should look like this:Enter a drug name in the search box to see if it needs approval before it's covered by a patient's plan.Providers must explain in writing why patients need a certain medication before Blue Cross NC can decide if it will be covered.To encourage the proper use of prescription medications, Blue Cross NC may restrict the amount of medicine an insurance plan covers. Please update your browser if the service fails to run our website.
Not all medication lists or formularies have non-formulary medications. Blue Cross Blue Shield of Texas is committed to giving health care providers with the support and assistance they need.
If there's a medical reason the patient needs a brand-name medication, please:Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Prior Authorization Form GEHA FEDERAL - STANDARD OPTION Anti-Obesity Agents (FA-PA) This fax machine is located in a secure location as required by HIPAA regulations. h�b```f``Jg`a`�[email protected] AF da��М���p��L#(f`L` ��������ٕY�e��g��`�,�:�`�AL����1�H;�0 e� �N�vXۤ ��>d�K�5��:ۺ_��(J�l'��N%��sw|�!�N�ӧ��Q��z~8G�Ϧ��c�EgW� A�#HQ\Q�Te0,�N'��?/��*Eg?N'G���^����DIL��`ҘIry9���-�.�&;����9?�E��BvS��pp5�r�fv:��`���NC��h���Z �5"$4RИSĪ
For self-funded and ASO patients, you may need to call Blue Cross NC Customer Service for medication limits that may apply.
w�^$��]�ӛ�� Prior Authorization Lists for Blue Cross Medicare Advantage (PPO) SM and Blue Cross Medicare Advantage (HMO) SM; Prior Authorization Lists for Designated Groups. If you are unsure if your patient's group is an underwritten or self-funded/ASO group, call the customer service number listed on the back of your patient's member ID card.For groups that, in 2013, had a $5000 lifetime maximum and were able to carry this over due to updates to the Affordable Care Act, this benefit will remain available. Your dashboard may experience future loading problems if not resolved. h�[k�0���`/-��jˆH�e ���20~p-5$v�ݭ��=G�/m��lٲtn:�|,%!\%B���x To find a drug, use the search above or select a letter from the list above.
Not all limited medications are listed. We’ve provided the following resources to help you understand Anthem’s prior authorization process and obtain authorization for your patients when it’s required.
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