Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1065 issues

How to Get Joenja (leniolisib) Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Joenja Approved by BCBS in New Jersey Blue Cross Blue Shield plans in New Jersey typically require prior authorization for Joenja (leniolisib) with specific APDS diagnostic criteria. The fastest path involves: (1) confirming genetic APDS diagnosis with molecular testing, (2) submitting PA through your specialist with imaging

Myths vs. Facts: Getting Amvuttra (vutrisiran) Covered by Blue Cross Blue Shield in Ohio - Appeals, Forms & Timeline

Quick Answer: Blue Cross Blue Shield covers Amvuttra (vutrisiran) for hATTR polyneuropathy and ATTR cardiomyopathy when strict criteria are met, including documented PND score ≤ IIIb and genetic confirmation. Submit prior authorization via Availity Essentials with complete medical records. If denied, you have 180 days to file external review through the

How to Get Onivyde (Irinotecan Liposome) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Appeal Guide with Forms and Timelines

Quick Answer: Getting Onivyde Covered by Blue Cross Blue Shield in Pennsylvania Blue Cross Blue Shield plans in Pennsylvania require prior authorization for Onivyde (irinotecan liposome) as a specialty cancer treatment. Submit PA requests through your plan's provider portal with pathology-confirmed metastatic pancreatic adenocarcinoma, ECOG performance status 0-1,

Work With Your Doctor to Get Procysbi Approved by Blue Cross Blue Shield in Virginia: Forms, Appeals, and Provider Scripts

Answer Box: Getting Procysbi Covered in Virginia To get Procysbi (cysteamine bitartrate DR) approved by Blue Cross Blue Shield in Virginia: 1) Work with your doctor to document nephropathic cystinosis diagnosis with elevated WBC cystine levels (>2 nmol ½ cystine/mg protein), 2) Submit prior authorization showing failure/intolerance to

How to Get Darzalex Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Darzalex Approved by Blue Cross Blue Shield in New York Darzalex requires prior authorization from all Blue Cross Blue Shield plans in New York. Submit your PA request using plan-specific forms with complete documentation: multiple myeloma diagnosis (ICD-10 C90.0), prior therapy failures, and medical necessity justification.

Get Jaypirca (Pirtobrutinib) Covered by Blue Cross Blue Shield in Florida: Complete Coding, Appeals & Forms Guide 2024

Answer Box: Getting Jaypirca (Pirtobrutinib) Covered in Florida Jaypirca (pirtobrutinib) requires prior authorization from Blue Cross Blue Shield in Florida for relapsed/refractory mantle cell lymphoma or CLL/SLL after BTK inhibitor failure. Submit PA requests via Availity.com with proper ICD-10 codes (C83.1 for MCL, C91.10-C91.12

How to Get Keppra (Levetiracetam) Covered by Blue Cross Blue Shield in Michigan: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Coverage Path To get Keppra (levetiracetam) covered by Blue Cross Blue Shield of Michigan: First, check your plan's formulary status by calling member services or logging into bcbsm.com. If prior authorization is required, your doctor must submit clinical documentation showing epilepsy diagnosis, seizure frequency,

Getting Onivyde (Irinotecan Liposome) Covered by Blue Cross Blue Shield of North Carolina: Complete PA Guide and Appeals Process

Answer Box: Quick Path to Onivyde Coverage Blue Cross Blue Shield of North Carolina requires prior authorization for Onivyde (irinotecan liposome), typically approved for FDA-indicated NALIRIFOX regimen in first-line metastatic pancreatic cancer. Your oncologist submits PA documentation including confirmed diagnosis, performance status, and treatment rationale. If denied, file internal appeal

How Long Does It Take to Get Palynziq (pegvaliase-pqpz) Approved by Blue Cross Blue Shield in North Carolina? Complete Timeline and Appeals Guide

Answer Box: Getting Palynziq Approved in North Carolina Blue Cross Blue Shield of North Carolina requires prior authorization for Palynziq (pegvaliase-pqpz) with a 15-business-day review timeline (72 hours expedited). The medication is non-formulary and typically requires trying sapropterin (generic Kuvan) first. Key steps: 1) Verify REMS program enrollment, 2) Submit

Renewing Cometriq (Cabozantinib) Approval with Blue Cross Blue Shield in Washington: Complete Timeline and Documentation Guide

Quick Answer: Blue Cross Blue Shield Washington typically requires renewal every 6-12 months for Cometriq (cabozantinib) with documented stable disease or response via imaging (CT/MRI every 2-3 months) and biochemical markers (calcitonin/CEA). Submit renewal 2-4 weeks before expiration through your oncologist with recent scans, lab trends, and toxicity