Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1266 issues

Myths vs. Facts: Getting Naglazyme (Galsulfase) Covered by Blue Cross Blue Shield in Washington

Quick Answer: Getting Naglazyme (galsulfase) covered by Blue Cross Blue Shield in Washington requires prior authorization with confirmed MPS VI diagnosis via enzyme assay, genetic testing, and clinical documentation. If denied, you have 180 days to appeal internally, then can request external review through Washington's Insurance Commissioner within

Renewing Orfadin (Nitisinone) Approval with Blue Cross Blue Shield in Illinois: Complete Timeline and Documentation Guide

Answer Box: Renewing Orfadin Coverage in Illinois Blue Cross Blue Shield of Illinois requires annual prior authorization renewal for Orfadin (nitisinone) with updated clinical documentation proving ongoing medical necessity. Submit renewal requests 30-60 days before expiration using the Illinois Uniform Prior Authorization Form through Prime Therapeutics, including current succinylacetone levels

Work With Your Doctor to Get Fintepla (Fenfluramine) Approved by Blue Cross Blue Shield in California: Complete Provider Collaboration Guide

Answer Box: Getting Fintepla Approved in California Fintepla (fenfluramine) requires prior authorization from Blue Cross Blue Shield California, including REMS enrollment documentation and echocardiogram results to confirm eligibility for Dravet or Lennox-Gastaut syndrome. Your doctor must first enroll as a prescriber and enroll you as a patient at FinteplaREMS.com,

How to Get Symdeko/Symkevi Covered by Blue Cross Blue Shield North Carolina: Complete Prior Authorization and Appeals Guide

Quick Answer: Blue Cross Blue Shield of North Carolina covers Symdeko/Symkevi (tezacaftor/ivacaftor) as a Tier 5 specialty medication requiring prior authorization and genetic testing documentation. Submit PA through your CF specialist with CFTR genotype results showing F508del or responsive mutations. If denied, appeal internally within 180 days, then

How to Get Vigabatrin (Sabril) Covered by Blue Cross Blue Shield of Texas: Complete PA Forms, Appeals, and Coding Guide

Answer Box: Getting Vigabatrin Covered in Texas Blue Cross Blue Shield of Texas requires prior authorization for vigabatrin (Sabril) with REMS enrollment and vision testing documentation. File PA using CVS Caremark Form 548-A, include ICD-10 codes (G40.822 for infantile spasms, G40.824 for refractory seizures), and submit baseline vision

Get Zolgensma Covered by Florida Blue Cross Blue Shield: Complete Prior Authorization and Appeals Guide (2025)

Quick Answer: Getting Zolgensma Covered by Florida Blue in 2025 Florida Blue requires prior authorization for Zolgensma with strict criteria: confirmed SMA diagnosis via genetic testing (bi-allelic SMN1 deletion), patient age under 24 months, negative AAV9 antibody testing, and comprehensive medical records. Submit through their PA portal with chart notes

Getting Vyondys 53 (Golodirsen) Covered by Blue Cross Blue Shield in Ohio: ICD-10, HCPCS J-Code, and Prior Authorization Guide

Answer Box: Getting Vyondys 53 Covered in Ohio Vyondys 53 (golodirsen) requires prior authorization from Blue Cross Blue Shield Ohio through their NovoLogix portal. You'll need genetic confirmation of DMD with exon 53-skippable mutation (ICD-10: G71.01), proper billing codes (HCPCS J1429, NDC 60923-0465), and clinical documentation. Submit

Coding That Helps Get Advate (octocog alfa) Approved by Blue Cross Blue Shield in Washington (ICD-10, HCPCS, NDC Guide)

Quick Answer: Getting Advate Covered in Washington Blue Cross Blue Shield of Washington requires prior authorization for Advate (octocog alfa) using specific medical codes. Use ICD-10 code D66 (hereditary factor VIII deficiency), HCPCS J7192 (factor VIII recombinant, per IU), and the product NDC. Submit via Premera's Availity portal

How to Get Uplizna (Inebilizumab) Covered by Blue Cross Blue Shield of Illinois: Complete Guide to Prior Authorization, Appeals, and State Protections

Answer Box: Getting Uplizna Covered by BCBS Illinois Blue Cross Blue Shield of Illinois (BCBSIL) requires prior authorization for Uplizna (inebilizumab), but Illinois' strong patient protection laws help secure coverage. For AQP4-positive NMOSD or IgG4-related disease, follow these steps: 1. Submit prior authorization through BCBSIL's provider portal

How to Get Oxervate (Cenegermin) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization Guide

Answer Box: Getting Oxervate Approved by Florida Blue Florida Blue requires prior authorization (PA) for Oxervate (cenegermin) with specific criteria: confirmed stage 2 or 3 neurotrophic keratitis, documented failure of preservative-free artificial tears for ≥2 weeks, and corneal sensitivity testing results. Submit PA via Availity.com or call 1-877-719-2583. First