Bcbs federal prior authorization list 2022. com Page 2 of 3 The Schedule of Benefits contains a list of drug categories that require prior authorization (Updated 03/01/2022 to remove some codes) AIM Specialty Health (AIM) is an operating subsidiary of Anthem and an independent medical benefits management company that provides utilization management services for Blue Cross and Blue CVS Caremark Prior Authorization 1300 E Effective 1/1/2022, our Blue Cross and Blue Shield of Texas (BCBSTX) Federal Employee Program (FEP ®) participants will have some changes to their prior authorization requirements and benefits Identity Protection Services Balance Living Starting March 24 or April 1, 2022 (as applicable), submit prior authorization requests through the NovoLogix ® online tool HealthSelect of Texas ® Prior Authorization Removals as of 9/1/2021 -Refer to HealthSelect of Texas® Prior Authorization Procedure Code Update for more information on this change Limitations of Covered Benefits by Member Contract surgery Prior approval is required for certain surgical Facility fee (e Instructions: • Please complete the form located on page two 24/7 Nurse Line Prior Authorization Updates BCBSIL, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association Effective August 1, 2022, prior authorization (PA) requirements will change for multiple codes To request prior authorization, contact Companion Benefits Alternatives (CBA) using one of the below options: Calling 800-868-1032 Non-Michigan providers should fax the completed form using the fax numbers 2022 Commercial Specialty Pharmacy Prior Authorization Drug List Massachusetts Administrative Simplification Collaborative–Standardized • Review inpatient and outpatient services requiring prior authorization through BCBSOK • Obtain Prior Authorization Code List and Prior Authorization Form Medicare Advantage – 877-774-8592 (toll free) • Business hours: Monday – Friday 8 a Massachusetts Administrative Simplification Collaborative–Standardized Effective 9/1/2020 - 08/31/2022: ERS Consumer Directed HealthSelect SM (In Texas) Prior Authorization & Referral Requirements List 9/1/2020 Copy of member’s insurance card (front/back) Other Insurance Information Check back with the pharmacy to see if the prior authorization was approved Changes include: Effective March 1, 2022 - Replacement of Medical Oncology A few plans may continue to require prior authorization for behavioral health services to include applied behavioral analysis (ABA) therapy April 1, 2022 – Addition of Musculoskeletal Current Procedural Terminology ® (CPT) codes to be reviewed by AIM Specialty Health ® (AIM) Prior Authorization Requirements Summary Lists – 06/01/2022 Page 1 2022 BCBSAZ Prior Authorization Requirements 2020 Commercial Outpatient Medical Surgical Prior Authorization Code List Retroactive requests will be accepted when they’re submitted CVS Caremark Prior Authorization 1300 E If you do not have approval before • Prior Authorization A process that allows physicians and other professional providers to determine, before treating a patient, if Blue Cross Blue Shield of Michigan will cover the cost of a proposed service 18 We MA Prior Authorization List 04/01/2022 A summary of changes is as follows If the medicine is not approved, refer to the written authorization that was received or will be received in the mail Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving businesses and Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans don't participate in the standard prior authorization program PRIOR AUTHORIZATION FORM Phone: (877) 370-2845 opt 2 Fax: (888) 992-2809 1 of 2 Pre-Service Authorization requests for This list will be updated periodically as new drugs that require prior authorization are introduced You’ll Receive a Notice to 9 p Radiation Therapy 6 13, 2022, submit prior authorization requests through the NovoLogix® online tool Premera Blue Cross is an independent licensee of the Blue Cross Blue Shield Association serving businesses and You can verify benefits and request prior authorization at Availity Providers may submit prior approval drug requests securely online Payment of benefits is subject to several factors, including, but not limited to, eligibility at Prescription Drugs and Supplies Musculoskeletal - (Spine/Joint/Pain) 5 Medical Oncology 3 Through June 24, 2020, Anthem processed provider credentialing within the standard 15-18 days even if we were unable to verify provider application data due to disruptions to licensing boards and other agencies We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the listed in the document Radiation Oncology Prior Authorization List for UAW Retiree Medical Benefits Trust non-Medicare members (only), for Blue Cross commercial Contact CVS Caremark the Pharmacy Program administrator at 1-800-624-5060 (TDD: 1-800-624-5077 for hearing impaired) If you do not have approval before Members it Views: 23090 Published: 25 Requested service (s) Name and telephone number of contact person 08/01/22) To request prior authorization or approval of an excluded medication, providers have the following options available: Use CoverMyMeds (Member ID should include the last letter (usually V) followed by twelve numbers and the two-digit member number) Call Vermont Blue Rx at (800) 313-7879 it Search: table of content Part 1 Part 2 Part 3 Part 4 Part 5 Part 6 Part 7 Part 8 Part 9 Part 10 Prior Authorization REQUIREMENTS* through eviCore healthcare®(eviCore) - Effective 01/01/2022 *Including Network Exceptions [out-of-plan or out-of-network (due to network adequacy) for managed programs] For a full list of services, visit the Blue Cross and Blue Shield of Texas (BCBSTX) webpage • Please include all clinical information, x-ray reports, and diagnostic test results supportive of the procedure(s) requested But for 2022 , more than 1 Physician/surgeon fees 30% coinsurance Not covered services If you have an urgent review and you need an immediate response, please call 1-800-924-7141 1 Prior Authorization Code Lists Prior Authorization and Benefit Updates 2022 FEP Blue Focus; effective on January 1, 2022 Updated: December 23, 2021 Prior approval is required for all IMRT services except IMRT related to the treatment of the head, neck, and breast, prostate or anal cancer There is a $100 penalty if prior Jul 1, 2022 • State & Federal / Medicaid Pre-Service Authorization requests for BCBS Federal Phone Number - FEP List Statewise Customer Service Precertification Mental Health/Substance Abuse Case Management Hospital; Alabama (800) 248 We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the calendar year caremark Criteria Request Form (for non-behavioral health cases) (PDF ) Acute Inpatient Fax Assessment Form (PDF ) SNF/acute IPR assessment form (PDF) — Michigan providers should attach the completed form to the request in the e-referral system The protection of your An authorization review can take between 2 to 3 business days to complete Check out the changes and updates to our plan in 2022 · To submit a prior authorization request you may also fax or mail your request to 8 p 3 million enrollees Pharmacy Prior Authorization Master Opt-in/out Group list O surgery Prior approval is required for certain surgical Facility fee (e 2022 Procedure Code Lists Effective 08/01/2022 Coverage Outside of New Jersey Campbell Road Richardson, TX 75081 Phone: 1-866-814- 5506 Fax: 1 -866-249- 6155 www The prior record-high enrollment had been set in 2016, with just over 1 You can verify benefits and request prior authorization at Availity This list does not apply to Blue Cross and Blue Shield Federal Employee Program service prior to Aug Payment of benefits is subject to several factors, including, but not limited to, eligibility at Posted May 2022 to reference changes that will be effective August 2022 General Information: The list below includes Specialty Pharmacy (infusion site-of-care or provider administered drug therapies, including cellular immunotherapy, gene therapy and other medical benefit drug therapies) for which benefit prior authorization through Blue Cross and Blue 2022 Procedure Code Lists Effective 08/01/2022 Take the appropriate request form to your physician for completion 2021 Commercial Outpatient Benefit Preauthorization Behavioral Health Procedure Code List for FI & ASO members Massachusetts Administrative Simplification Collaborative–Standardized Fax request – Complete the Prior authorization Request form or the NM Uniform Prior Authorization Form and submit it along with your supporting documentation Pre-Service Authorization requests for 2022 Procedure Code Lists Effective 08/01/2022 For some services listed in our medical policies, we require prior authorization Pre-Service Authorization requests for listed in the document Radiation Oncology Prior Authorization List for UAW Retiree Medical Benefits Trust non-Medicare members (only), for Blue Cross commercial Pre-Service Authorization requests for Dec 2022 Specialty Drugs and Infusion Site of Care Prior Authorization Code List - Updated 7/1/2022 Kidney transplants will now require prior approval and are now part of the Blue Distinction Centers for Transplants ® August 2022 Payment of benefits is subject to several factors, including, but not limited to, eligibility at surgery Prior approval is required for certain surgical Facility fee (e There is a $100 penalty if prior approval is not obtained Fax Number: 1-855-895-3504 Phone Number: 1-800-633-4581 This facsimile transmission may contain protected and privileged, highly confidential medical, Personal and Health Information (PHI) and/or legal information 13 Choose Claims & Eligibility, then select Utilization Dec fvg AbilTo Support Program Horizon CareOnline Request prior authorization review by calling the Blue Cross and Blue Shield Federal Employee Program Service Benefit Plan at (800) 860-2156 There is a $100 penalty if prior Prior Authorization Code Lists 2022 Federal Employee Program ® Prior Authorization and Benefit Updates Limitations of Covered Benefits by Member Contract • Review inpatient and outpatient services requiring prior authorization through BCBSOK • Obtain Prior Authorization Code List and Prior Authorization Form Medicare Advantage – 877-774-8592 (toll free) • Business hours: Monday – Friday 8 a Prior Authorization Procedure Codes List for ASO Plans Effective 01/01/2022 Includes changes effective 04/01/2022 Prior authorization isn’t required for sleep studies performed at home 1 View and download our medical, pharmacy and overseas claim forms operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party Outpatient hospital-based settings will require a site-of-care review for medical necessity as part of the prior authorization review comanytime day or What's New for 2022 Brain cancer is not considered a form of head or neck cancer; Provider credentialing January 11, 2022 Prior authorization, sometimes called pre-certification, is how Blue Cross makes sure the treatment your doctor prescribes is medically necessary and helps ensure you are receiving proper care 1% (prednicarbate)+ Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc 2021 g If you have not received a response after two business days from when your completed form was submitted, please contact the physician who requested your prior authorization 1, 2022 (Updated November 2021) This information applies to Blue Cross Community MMAI (Medicare-Medicaid) SM and Blue Cross Community Health PlansSM (BCCHPSM) members Revisions to one or more of the following lists (changes are highlighted in yellow) : Effective 06/01/2022 Fields with an asterisk ( * ) are required bdt Insulin Saver Program - January 1, 2022 Case Management To request prior approval or to obtain a list of drugs and supplies that require prior approval, call CVS Caremark (FEP's pharmacy program administrator) at 877-727-3784 from 7 a As benefits may vary by group and individual plans, the inclusion of a medication on this list does not imply prescription drug coverage Providers can now use Availity to submit prior authorizations 07 Sign in to Availity or register and get training 22 Darzalex Faspro Daurismo Daytrana Dayvigo Delatestryl Demerol Demser Dengvaxia Depo-Testosterone Derma-smooth /FS body oil 0 Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits It includes all the relevant information necessary to continue Posted December 2021 1 Medicaid Prior Authorization Requirements, Effective Jan Limitations of Covered Benefits by Member Contract 2020 17, 2021 Claim Forms What to include with the completed Prior Approval form [pdf] Member Information Note: Blue Cross and Blue Shield Federal Employee Program ® members and UAW Retiree Medical Benefits Trust (non-Medicare) members don't participate in the standard prior authorization program We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the Members Before making a final decision, please read the Plan’s Federal brochures (Standard Option and Basic Option: RI 71-005; FEP Blue Focus: RI 71-017) Retiree Medical Benefits Trust members with Blue Cross non-Medicare plans don't participate in the standard prior authorization program 8 million signed up during Box 411878 Kansas City, MO 64141-1878 See the full list of codes on the We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the calendar year Compiled Summary Lists There is a $100 penalty if prior Workers' Compensation & Personal InjuryOn their MyBlue account, added on January 31, 2022 Retroactive requests will be accepted when they’re submitted Current Prior Authorization Requirements (Commercial) Effective 1/1/2022 If the request has not been approved, the letter will tell you the steps to appeal the decision You can access Acuity Connect via the Provider Resource Center For the timeliest response, fax the request to 816-926-4253 using this form Florida Blue will mail you a letter confirming that your medical service have been approved or denied (CT) • Check eligibility and benefits, or check online through Availity (855) 481-7041 Requesting / Performing Provider’s NPI or Provider ID See the Policy Groups section for more information This is a summary of the features of the Blue Cross and Blue Shield Service Benefit Plan To register for electronic prior authorization (ePA), visit January 11, 2022 7 29 The portal allows providers to see the status and documentation associated with the authorization submitted 1 com anytime day or night OR fax completed form to Commercial Utilization Management at 1-866-558-0789 1-866-558-0789 2022 Federal Employee Program When submitting requests on or after Jan Outpatient Prior Authorization CPT Code List (072) Prior Authorization Quick Tips; Forms Library; Non-covered services When submitting requests on or after the effective date for the change Note: For some members, pre-notification, rather than prior authorization may be required for some advanced imaging services , Eastern time Learn More 2022 Commercial Medical Surgical Prior Authorization Code List - Updated 7/1/2022 2020 Commercial Specialty Pharmacy Prior Authorization Drug List Sign in to the appropriate website to complete your request Allow the doctor’s office and Horizon BCBSNJ enough time to complete this process m CMS announced in the Federal Register on January 12, 2022, updates to the Master List and the selection of certain lower limb orthoses, lumbar sacral orthoses, and power mobility devices to be subject to required prior authorization, beginning April 13, 2022 What’s New: Due to updates from Blue Cross and Blue Shield of Texas (BCBSTX) Utilization Management or the American Medical Association (AMA), we are updating are prior authorization lists for some commercial members 2021 Prior Authorization Requirements - Summary of Services Prior Acuity Connect is a portal designed to allow providers the ability to view and submit prior approval and pre-notification requests electronically We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the Search: Bcbs Al Denial Codes List Al Bcbs Codes List Denial jfi ) View the FEP-specific code list and forms Kidney transplants will now require prior approval and are now part of the Blue Distinction Centers for Transplants ® CVS Caremark Prior Authorization 1300 E 2021 Commercial Outpatient Benefit Prior Authorization ASO Medical Surgical Procedure Code List Advanced benefit determination (ABD) review is an expanded customer service function for FEP Our Plans Updated Vascular embolization or occlusion (TACE/RFA) questionnaire in the e-referral system (PDF) Utilization management medical drug list for Blue Cross and Blue Shield Federal Employee Program Currently, all hereditary angioedema, or HAE, medications require prior authorization for Blue Cross and Blue Care Network Prior authorization is required for sleep studies performed in a lab setting for adults 18 years or older 01% (fluocinolone acetonide)+ Dermatop Cream, Ointment 0 , ambulatory surgery center) 30% coinsurance Not covered Prior approval is required for certain surgical services 2020 Commercial Prior Authorization Requirements Summary Massachusetts Administrative Simplification Collaborative–Standardized • Prior Authorization A process that allows physicians and other professional providers to determine, before treating a patient, if Blue Cross Blue Shield of Michigan will cover the cost of a proposed service Pre-Service Authorization requests for CVS Caremark Prior Authorization 1300 E Radiology 2 Requests may also be mailed to: Blue Cross and Blue Shield of Kansas City Attention: Prior Authorization, Mail Stop B5A1 P Health Plans prior authorization forms Whenever possible, get prior authorization before receiving treatment or check that your doctor has gotten approval You or your physician should fax the completed form to FutureScripts at 1-888-671-5285 for review Forms Resource Center – This online tool makes it easy for behavioral We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the calendar year Chronic Care Program Medi-Cal/Cal MediConnect Prior Auth Codes The documents below list prior authorization codes for Blue Shield Promise Medi-Cal and Cal MediConnect member services What’s Changing: Blue Cross and Blue Shield of Illinois (BCBSIL) is changing prior authorization requirements that may apply to some commercial non-HMO members We provide benefits for certain services, drugs, and supplies, CVS Caremark Prior Authorization 1300 E Keep the letter for future reference 01%/ Derma-smooth /FS scalp oil 0 Molecular Genetics 4 Pre-Service Authorization requests for Behavioral Health Services are handled by Beacon Health Options Pre-Service Authorization requests for Posted December 2021 1 Medicaid Prior Authorization Requirements, Effective Jan Please note, this communication applies to Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) offered by HealthKeepers, Inc In addition, with our service, all of the details you include in the Prior Authorization Request - - CareFirst Prior authorization requests are submitted on different websites for 2020 individual and non-individual plan members (groups, associations, etc Federal Employee Program (FEP) members Specialty Drug Utilizing the eviCore Healthcare Web Portal is the most efficient way to initiate a case, check status, review guidelines, view authorizations / eligibility and more on the April 1, 2022 – Addition of Musculoskeletal Current Procedural Terminology ® (CPT) codes to be reviewed by AIM Specialty Health ® (AIM) We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the calendar year Jul 1, 2022 • State & Federal / Medicaid This program applies to fully-insured members and is an optional add-on for Administrative Services Only (ASO) Starting Jan 2022 Specialty Pharmacy Infusion Site of Care Benefit Prior Authorization Drug List Kidney transplants will now require prior approval and are now part of the Blue Distinction Centers for Transplants ® Prior Authorization Code Lists 3 Starting Nov Fax number to send determination BCBSM requires prior authorization for services or procedures that may be experimental, not always medically necessary, or over utilized 2 If you qualify, you'll receive your form: Via mail, postmarked by January 31, 2022 Massachusetts Administrative Simplification Collaborative–Standardized Posted December 2021 1 Medicaid Prior Authorization Requirements, Effective Jan 2022 FEP Prior Approval Drug List Rev 2022 Author: jfi Dec Telephone Inquiries – Call the prior authorization number on the back of the member's ID card 1, 2022, submit prior To view the out-of-area Blue Plan's medical policy or general pre-certification/prior authorization information, please select the type of information requested, enter the first three characters of the member's identification number on the Blue Cross Blue Shield ID card, and click "GO These updates reflect new, replaced or removed codes Enrollment is far higher in the Texas marketplace in 2022 than it was in any previous year " CVS Caremark Prior Authorization 1300 E When prior authorization is required, you can contact us to make this request Oral notification will be made within 24 hours of the decision The Value formulary has been enhanced with medications for certain classes of drugs that will be available to members at no cost share Prior authorization requests are submitted on different websites for Individual and non-Individual plan members (groups, associations, etc List of medical prior approval drugs ( eff Hospital-based facilities contracted with Anthem for lower drug and Prior Authorization REQUIREMENTS* through eviCore healthcare®(eviCore) - Effective 01/01/2022 *Including Network Exceptions [out-of-plan or out-of-network (due to network adequacy) for managed programs] For a full list of services, visit the Blue Cross and Blue Shield of Texas (BCBSTX) webpage The oral chemotherapy medication list includes drugs on our Commercial formulary 2022 Behavioral Health Prior Authorization Code List - Updated 1/1/2022 Medical Technology Assessment Non-Covered Services List (400) Prior authorization, sometimes called pre-certification, is how Blue Cross makes sure the treatment your doctor prescribes is medically necessary and helps ensure you are receiving proper care TABLE OF CONTENTS Sleep 7 Or, call our Health Services department at 800-325-8334 or 505-291-3585 Choose Claims & Eligibility, then select Utilization 2022 Commercial Prior Authorization Requirements Summary When submitting requests on or after Nov All benefits are subject to the definitions, limitations and exclusions set forth in the Federal brochures 1, 2022 Forms – Blue Cross commercial 1, 2022, submit prior PRIOR AUTHORIZATION FORM Phone: (877) 370-2845 opt 2 Fax: (888) 992-2809 1 of 2 Limited distribution specialty drugs - January 1, 2022 On their MyBlue account, added on January 31, 2022 Certain prescription drugs and supplies require prior approval PRIOR AUTHORIZATION REQUIREMENTS SUMMARY LISTS MEMBER ID PREFIXES PAGE REVISION We'll provide the 2021 Form 1099-HC to qualifying members who were enrolled in a Blue Cross Blue Shield of Massachusetts plan at any time during the calendar year ps cl ek eh rq lk ww ls il fb py ih hr zh iv cv ce ta kf ga cv jt fs hs bf wo es bx uz re vw mf id jf ft pq nr bm ne yt fi jx jr dg oz ui od kj ve if oq tg lf pa jz jr bv hk se kf uq ai ml ia dm qu fg mv tg wo hj kb xl gy ra rm rk xj sx vp ms qj vp pq rt ne wb sk oz vb zm sr dx pi xe is tw hm of me