Blue Cross Blue Shield Precertification

1110488 712020 IBC Specialty drugs requiring precertification All listed brands and their generic equivalents or biosimilars require precertification. Members of the Federal Employee Blue CrossBlue Shield Service Benefit Plan FEP are subject to different prior authorization requirements.

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Once logged in select Patient Registration Authorizations Referrals then choose Authorizations or AuthReferral Inquiry as appropriate.

Blue cross blue shield precertification. Precertification requirements To request or check the status of a prior authorization request or decision for a particular plan member access our Interactive Care Reviewer ICR tool via Availity. This list is subject to change. Precertification is our assessment of your patients symptoms and your proposed treatment plan in advance of care.

Products and services are provided by Horizon Blue Cross Blue Shield of New Jersey Horizon Insurance Company Horizon Healthcare of New Jersey Braven Health andor Horizon Healthcare Dental Inc each an independent licensee of the Blue Cross Blue Shield Association. Precertification approval decisions are based on information provided during the request process. Fax all requests for services that require precertification to.

Be sure to check your coverage manual to find out if you must go to a Blue Distinction Center for certain procedures to be covered. Availity LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield HealthPlus. If your doctor ordered a test or treatment you may need to get approval from BCBSTX first.

And QCC Insurance Company and with Highmark Blue Shield independent licensees of the Blue Cross and Blue Shield Association. To view the out-of-area Blue Plans medical policy or general pre-certificationpre-authorization information please select the type of information requested enter the first three letters of the members identification number on the Blue Cross Blue Shield ID card and click GO. See if you need a precertification or check an existing one For additional guidelines read our Provider Preauthorization and Precertification Requirements PDF.

You can call the precertification number on the back of your member ID card to see if we have received the request. This webpage applies only to Blue Cross and Blue Shield of Alabama individual and family non-group plans and underwritten employer group plans. Services billed with the following revenue codes always require precertification.

Blue Shield and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield. Pending FDA approval. When selecting a Blue Distinction Center please confirm the Blue Distinction Center facility or provider is in your health plan network.

Company providing services for Blue Cross and Blue Shield of Nebraska an Independent Licensee of the Blue Cross and Blue Shield Association. This information is not to be relied upon as pre-authorization or pre-certification for health care services and is not a guarantee of payment. SM TM Registered and Service Marks and Trademarks are the property of their respective owners.

Utilization Management Program and Precertification. Because you are still responsible for ensuring that your care is precertified you should always ask your provider if they have contacted us and provided all the necessary information. From the Availity home page select Patient Registration from the top navigation.

0901 09050907 0913 0917. Registered Marks of the Blue Cross and Blue Shield Association. Provider Preauthorization and Precertification Requirements - Blue Cross PPO and Medicare Plus Blue SM PPO PDF Northwood DMEPOS Management Program FAQ PDF Northwood DMEPOS Management Program Procedure Codes Requiring Prior Authorization PDF Patient eligibility precertification and preauthorization contacts.

MEDICAL POLICIES REQUIRING PREAUTHORIZATION POLICY NUMBER POLICY NAME I0 PROCEDURES MEDICAL REVIEW I31 CHELATION THERAPYCHEMICAL ENDARTERECTOMY. Blue Cross and Blue Shield of Massachusetts Inc and Blue Cross and Blue Shield of Massachusetts HMO Blue. Type of information being requested.

Select AuthReferral Inquiry or Authorizations. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. For both outpatient procedures and treatment requiring an inpatient stay call 800 633-4581 to obtain prior authorization.

The following information describes the general policies of Blue Cross and Blue Shield of Louisiana and its subsidiary HMO Louisiana Inc. This is called prior authorization or pre-approval. Precertification for commercial and Medicare Advantage members Certain services require precertification from Independence Blue Cross Independence prior to being performed.

And is provided for reference only. To determine if your employer plan is subject to these additional precertification requirements your benefit booklet will say the plan benefits are. Although precertification may not be required for a particular service the claim for the service may still be subject to review for medical necessity as well as benefits limitations exclusions and waivers if applicable.

This includes certain injectable and infusion specialty drugs that are administered by providers and eligible for coverage under the medical benefit. To complete a precertification medical records might be required.

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