In some cases, step therapy requirements may require members to first try over-the-counter products. Step therapy requires that the member has tried an alternative therapy first, or that the prescriber has clinically documented why the member cannot take the alternative therapy. For oncology and supportive care medical benefits drugs, submit requests to Carelon Medical Benefits Management (formerly known as AIM Specialty Health ®). Learn about submitting requests to Carelon electronically and through other methods on Blue Cross Medical Benefit Drugs or on BCN Medical Benefit Drugs.For most medical benefit drugs, including CAR-T cell therapy drugs, submit requests through NovoLogix ®. Learn about submitting requests through NovoLogix and through other methods on Blue Cross Medical Benefit Drugs or on BCN Medical Benefit Drugs.Learn about submitting requests electronically and through other methods on Blue Cross Pharmacy Benefit Drugs or on BCN Pharmacy Benefit Drugs. For pharmacy benefit drugs, submit requests through CoverMyMeds.Submitting prior authorization requestsįor drugs that require prior authorization, providers should submit requests as follows: This includes cardiac implantable devices and services, for dates of service on or after Jan. We require providers to request prior authorization for certain medicines, such as specialty drugs, to ensure certain clinical criteria are met. Carelon-Managed Procedures (formerly AIM) Providers must obtain authorization from Carelon Medical Benefits Management (formerly AIM Specialty Health ) for the following services: Cardiology services - Medicare Plus Blue SM. To register, visit the Webinars and Workshops page.To help make sure Blue Cross Blue Shield of Michigan and Blue Care Network members receive the most appropriate and cost-effective therapy, we require providers to take additional steps before certain drugs are eligible for reimbursement. (CT),Ĭomplimentary training for PPO providers, billing services, clinical and administrative staff who are new or already participating in the BCBSIL network If you do not have online access, use our automated phone system for eligibility and benefits and other self-service requests View Provider Network Consultant Assignments Our PNCs can offer information on how to use online tools, BCBSIL products and initiatives, provider education opportunities and personalized office visits. Government Provider Network Services Hotlinesīlue Cross Community Health Plans SM (BCCHP SM)īlue Cross Community MMAI (Medicare-Medicaid Plan) SMīlue Cross Medicare Advantage SM (HMO and PPO) Report concerns to the BCBSIL Special Investigations Department (SID) Verify eligibility and benefits and/or check claim status for FEP members The PCP is responsible for indicating the number of visits and type of specialty care. Access to these Guidelines and Pathways is. The members PCP must submit a referral to Tufts Health Public Plans. Please use these new numbers to submit AIM prior authorization requests. Effective August 15, 2022, the old phone number for AIM will no longer be available for requests. As always, the best way to reach AIM is to use the. In April 2022, AIM Specialty Health ® (AIM) ® launched new phone numbers for prior authorization requests for Anthem Blue Cross and Blue Shield. Please use this new number to submit new prior authorization requests to AIM or to get an update on an existing request after April 1, 2022. The new phone number is listed below and will go into effect on April 1, 2022. They are based on data from peer-reviewed scientific literature, from criteria developed by specialty societies, and from guidelines adopted by other health care organizations. Blue Cross Blue Shield of Massachusetts uses AIM Specialty Health®, an independent company, to administer a prior authorization program for genetic tests as of January 1, 2019. Wisconsin to use to submit prior authorization requests. Obtain benefit preauthorization for certain care categories The Guidelines and Pathways are designed to evaluate and direct the appropriate utilization of certain health care services. Register with Availity Essentials to verify eligibility and benefits, submit benefit preauthorization requests, obtain claim status, view provider claim summaries and moreĬlient Services: 1-800-AVAILITY (282-4548)Ĭall for out-of-state member eligibility and benefits 1, 2021) Blue Cross and Blue Shield of Oklahoma (BCBSOK) has contracted with Carelon Medical Benefits Management to provide certain utilization management services. Obtain or confirm a patient’s Radiology Quality Initiative (RQI) number Services requiring prior authorization through Carelon Medical Benefits Management, formerly AIM Specialty Health, (Effective Jan.
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