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https://www.ibx.com/pdfs/providers/policies_guidelines/preapproval/fep_precert.pdf
determine compliance with FEP medical policies and guidelines. Should services be denied for lack of medical necessity, reimbursement will not be made and the member may not be billed. *Exception: no retrospective review will be done for medical necessity for RTC. All precertification requirements must be met prior to admission. 71554 (1/17) FEP
https://www.fepblue.org/prior-approval
How to Obtain Prior Approval. There are three ways to get Prior Approval: Your doctor can submit an electronic prior approval; Your doctor can call us toll-free at 1-877-727-3784 between 7 a.m. and 9 p.m. Monday through Friday, Eastern time. This phone number is only for doctor’s offices. Your doctor can submit a paper prior approval.
https://www.fepblue.org/faqs-pharmacy
Pharmacy benefits under Basic Option and FEP Blue Focus are available only if you use one of our Preferred retail pharmacies or the Specialty Drug Pharmacy Program. Standard Option members can purchase prescription drugs and supplies from a Non-preferred pharmacy, but will have to pay the full amount for these items when they are filled.
https://members.bcidaho.com/benefits-and-coverage/benefits-prior-authorization-information.page
It is a pre-service determination of medical necessity based on information provided to Blue Cross of Idaho at the time the prior authorization request is made. Blue Cross of Idaho retains the right to review the medical necessity of services, eligibility for services and benefit limitations and exclusions after you receive the services.
https://www.regence.com/provider/library/whats-new/covid-19
Urgent and emergent transport does not require pre-authorization. Any emergency room visit that results in an in-patient admission, directly related to COVID-19, does not require a pre-authorization. Oxygen concentrators used by Medicare Advantage members for more than 90 days will require pre-authorization effective July 1, 2020.
https://www.caremark.com/portal/asset/PACover.pdf
2020 FEP Prior Approval Drug List Rev. 3 31.20 Desonate Gel 0.05% Desonide Cream Lotion, Ointment 0.05% Desowen Lotion 0.05% (desonide)+ Desoxyn Dexedrine Dexilant D Dexmethylphenidate extroamphetamine Diabetic test strips Diacomit Diclegis Diclofenac Powder Differin Entyvio
https://www11.anthem.com/ca/provider/f3/s1/t4/pw_a112996.pdf?refer=employer
Services Requiring Prior Authorization The table below outlines the services that require Prior Authorization (PA) for Anthem Blue Cross ... Dental Services In-patient facility and anesthesia services require PA from Anthem Blue Cross. For assistance with dental inquiries, please contact our Customer ... both delivery types require notification ...
https://www.bcbstx.com/provider/clinical/preauthorization.html
Prior Authorization also referred to as preauthorization, prospective review, prenotification or prior approval are all names referring to the prior assessment that proposed services are medically necessary, are an appropriate treatment for a Blue Cross and Blue Shield of Texas (BCBSTX) member and are a covered medical expense of the member ...
https://www.anthem.com/wps/portal/ca/footer?content_path=provider/f0/s0/t0/pw_b147314.htm&label=General%20Pre-Certification/Pre-Authorization%20Information
PLEASE READ: Members of some group health plans may have terms of coverage or benefits that differ from the information presented here. The following information describes the general policies of Anthem Blue Cross and is provided for reference only. 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.
https://www11.anthem.com/ca/provider/f1/s0/t0/pw_a092321.pdf?refer=footer
Prior Authorization List DISCLAIMER: This list represents our standard codes for pre -service review requirements. Please note that a request may require a letter of intent and photo. Please call (800) 274- 7767 or (866) 470- 6244 to verify the specific requirements of the patient’s plan as …
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