Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1062 issues

How to Get Revlimid (Lenalidomide) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Revlimid Covered by Blue Cross Blue Shield in Virginia Blue Cross Blue Shield of Virginia requires prior authorization for Revlimid (lenalidomide), with approval depending on FDA-approved indications like multiple myeloma, documented prior treatment failures, and enrollment in the mandatory Lenalidomide REMS program. Your oncologist must submit clinical

How to Get Trikafta Approved by Blue Cross Blue Shield in Georgia: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Trikafta Covered by BCBS Georgia Trikafta requires prior authorization from Blue Cross Blue Shield of Georgia (Anthem). To get approved: (1) Have your CF specialist submit a PA through Anthem's provider portal with genetic testing showing F508del or eligible CFTR mutations, (2) Include diagnosis (ICD-10

How to Get Orfadin (nitisinone) Covered by Blue Cross Blue Shield in Ohio: Complete PA Guide with Appeals Timeline

Answer Box: Blue Cross Blue Shield Ohio (Anthem/Elevance Health) covers Orfadin (nitisinone) for hereditary tyrosinemia type 1 (HT-1) with mandatory prior authorization. Submit PA with confirmed HT-1 diagnosis (elevated succinylacetone or FAH gene variants), specialist consultation, and dietary restriction plan via your provider portal or specialty pharmacy. Appeals follow

How to Get Hemlibra (Emicizumab) Covered by Blue Cross Blue Shield in New Jersey: Complete PA Guide with Appeals Timeline

Answer Box: Getting Hemlibra Covered in New Jersey Horizon Blue Cross Blue Shield of New Jersey covers Hemlibra (emicizumab) as a specialty medication requiring prior authorization through its Medical Injectables Program. First step: Have your hematologist submit a Medical Necessity and Appropriateness Review (MNAR) including hemophilia A diagnosis, inhibitor status,

Work With Your Doctor to Get Haegarda Covered by Blue Cross Blue Shield in New York: Complete Prior Authorization Guide

Answer Box: Getting Haegarda Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield (BCBS) requires prior authorization for Haegarda with confirmed HAE diagnosis (low C4, C1-INH levels), attack history ≥2/month, and specialist prescriber. Fastest approval path: Submit complete PA packet via Availity provider portal with

How to Get Prolastin-C Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization and Appeals Guide

Quick Answer: Getting Prolastin-C Approved by Florida Blue Cross Blue Shield To get Prolastin-C covered by Blue Cross Blue Shield in Florida, you need prior authorization showing severe alpha-1 antitrypsin deficiency (AAT level <57 mg/dL, Pi*ZZ genotype), emphysema with FEV1 25-80% predicted, and proper ICD-10 coding (E88.

Renewing Symdeko/Symkevi Coverage with Blue Cross Blue Shield Michigan: Complete Guide to Prior Authorization Renewals and Appeals

Answer Box: Renewing Symdeko/Symkevi with BCBS Michigan Blue Cross Blue Shield of Michigan requires annual prior authorization renewal for Symdeko/Symkevi with updated clinical documentation. Submit renewal 30-60 days before expiration with: recent pulmonary function tests, liver function labs (every 3 months year 1, then annually), CF specialist notes

Denied for Mycapssa (Octreotide Oral) by Blue Cross Blue Shield in Georgia? Complete Appeals Guide with Templates

Quick Answer: Getting Mycapssa Covered by BCBS Georgia To get Mycapssa (oral octreotide) approved by Blue Cross Blue Shield in Georgia: Submit prior authorization with documented acromegaly diagnosis (ICD-10 E22.0), proof of prior response to injectable octreotide/lanreotide, and endocrinologist prescription. If denied, file internal appeal within 180 days

How to Get Advate (octocog alfa) Covered by Blue Cross Blue Shield of Texas: Complete Coding, Prior Authorization, and Appeal Guide

Answer Box: Getting Advate Covered by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Advate (octocog alfa) with specific coding: ICD-10 D66 for hemophilia A, HCPCS J7192 for medical benefit billing, and NDC for pharmacy benefit. Submit PA with factor VIII levels, bleeding history, and weight-based

The Requirements Checklist to Get Soliris (eculizumab) Covered by Blue Cross Blue Shield in Pennsylvania

Quick Answer: Your Path to Soliris Approval Getting Soliris (eculizumab) covered by Blue Cross Blue Shield in Pennsylvania requires meeting strict clinical criteria including confirmed diagnosis (PNH, aHUS, gMG, or NMOSD), proof of meningococcal vaccination at least 2 weeks before treatment, and documentation of failed standard therapies. Submit your prior