Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 103 issues

How to Get Keytruda (Pembrolizumab) Covered by Blue Cross Blue Shield in Ohio: Complete Guide with Forms and Appeal Scripts

Answer Box: Getting Keytruda Covered in Ohio Keytruda (pembrolizumab) requires prior authorization from Blue Cross Blue Shield in Ohio. The fastest path to approval involves three steps: 1) Gather biomarker test results (PD-L1, MSI-H, or TMB-H as required by your cancer type), 2) Submit complete prior authorization through your provider&

How to Get Myozyme (alglucosidase alfa) Covered by Blue Cross Blue Shield of Illinois: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Myozyme Covered by BCBS Illinois Blue Cross Blue Shield of Illinois requires prior authorization for Myozyme (alglucosidase alfa) for Pompe disease treatment. The fastest path to approval involves three key steps: (1) Submit complete diagnostic documentation including GAA enzyme assay and genetic testing results, (2) Have your

Coding That Helps Get Vigabatrin (Sabril) Approved by Blue Cross Blue Shield in North Carolina: ICD-10, HCPCS, and NDC Guide

Answer Box: Get Vigabatrin Covered by Blue Cross Blue Shield in North Carolina Vigabatrin requires prior authorization from Blue Cross Blue Shield NC with specific coding requirements. Use ICD-10 code G40.821 (infantile spasms) or G40.219 (refractory complex partial seizures), include NDC numbers for billing, and ensure REMS program

Renewing Vimizim (Elosulfase Alfa) Approval with Blue Cross Blue Shield of Texas: 2025 Requirements & Timeline

Answer Box: Vimizim Renewal with Blue Cross Blue Shield of Texas Good news for HealthSelect members: As of September 2024, Blue Cross Blue Shield of Texas HealthSelect plans no longer require prior authorization for Vimizim (elosulfase alfa) renewals. However, you still need an in-network PCP referral on file. For other

Get Tecentriq (Atezolizumab) Covered by Blue Cross Blue Shield in Virginia: Complete Prior Authorization Guide

Answer Box: Tecentriq (atezolizumab) requires prior authorization from Blue Cross Blue Shield in Virginia for all 2024 plans. Success depends on meeting FDA-approved indication criteria, proper PD-L1 testing (≥1% for adjuvant NSCLC, ≥50% for first-line metastatic), and comprehensive documentation. If denied, you have 120 days to file an external review

How to Get Advate (Octocog Alfa) Covered by Blue Cross Blue Shield in Virginia: Coding, Appeals, and Prior Authorization Guide

Answer Box: Getting Advate Covered in Virginia Anthem Blue Cross Blue Shield Virginia requires prior authorization for Advate (octocog alfa) using HCPCS code J7194 and ICD-10 code D66. Submit PA requests through the Availity Essentials portal with complete clinical documentation including hemophilia A diagnosis, factor VIII levels, and treatment history.

Resources to Get Humate-P Covered by Blue Cross Blue Shield in Florida: Forms, Portals & Appeals

Answer Box: Quick Start Guide Blue Cross Blue Shield Florida (Florida Blue) requires prior authorization for Humate-P for von Willebrand disease and hemophilia A treatment. The fastest path to approval: (1) Have your prescribing physician submit the prior authorization request via the Florida Blue provider portal or call 1-877-719-2583, (2)

Work With Your Doctor to Get Lutathera (Lutetium Lu-177 Dotatate) Approved by Blue Cross Blue Shield in New Jersey

Getting Lutathera Covered: Your Path to Approval Lutathera (lutetium Lu-177 dotatate) requires prior authorization from Blue Cross Blue Shield in New Jersey. Success depends on documenting somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (GEP-NETs), progression on first-line somatostatin analog therapy, and meeting specific medical necessity criteria. The fastest path: work closely with

How to Get Elevidys Gene Therapy Covered by Florida Blue Cross Blue Shield: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Elevidys Covered in Florida Elevidys requires prior authorization from Florida Blue Cross Blue Shield with strict eligibility criteria: genetic DMD confirmation, ages 4-5 years, negative anti-AAV antibodies, and treatment at certified centers like Nicklaus Children's Hospital. The fastest path: 1) Gather genetic testing and clinical

Do You Qualify for Uplizna Coverage by Blue Cross Blue Shield in Pennsylvania? Decision Tree & Next Steps

Answer Box: Your Path to Uplizna Coverage Most likely eligible if: You have confirmed AQP4-positive NMOSD or IgG4-related disease, negative hepatitis B screening, and a neurologist's prescription. First step: Contact your Blue Cross plan to request prior authorization forms—Highmark members use their provider portal, Independence Blue Cross