Topic

Blue Cross Blue Shield (BCBS Association)

A collection of 1266 issues

How to Get Elzonris (tagraxofusp-erzs) Covered by Blue Cross Blue Shield in New York: Complete Appeals Guide with Forms and Timelines

Answer Box: Getting Elzonris Covered in New York Elzonris (tagraxofusp-erzs) requires prior authorization from Blue Cross Blue Shield for BPDCN treatment. New York patients need: confirmed BPDCN diagnosis with CD123-positive pathology, serum albumin ≥3.2 g/dL, and a capillary leak syndrome monitoring plan. If denied, you have 4 months

How to Get Amondys 45 (Casimersen) Covered by Blue Cross Blue Shield in Ohio: Complete Prior Authorization Guide

Answer Box: Getting Amondys 45 Covered by Blue Cross Blue Shield in Ohio Blue Cross Blue Shield Ohio (Anthem) requires prior authorization for Amondys 45 (casimersen) for DMD patients with confirmed exon 45 skipping-amenable mutations. Submit form CC-0189 via Availity.com with genetic testing, 6-minute walk test results, and specialist

How to Get Amondys 45 (Casimersen) Covered by Blue Cross Blue Shield Michigan: Complete Prior Authorization & Appeals Guide

Answer Box: Getting Amondys 45 Covered in Michigan Blue Cross Blue Shield of Michigan (BCBSM) currently considers Amondys 45 (casimersen) investigational/experimental, requiring prior authorization that's typically denied. However, Michigan patients have strong appeal rights through DIFS external review. Fastest path to approval: 1. Submit prior authorization with

Do You Qualify for Voydeya (danicopan) Coverage by Blue Cross Blue Shield in New York? Decision Tree & Next Steps

Answer Box: Your Fastest Path to Voydeya Coverage If you have paroxysmal nocturnal hemoglobinuria (PNH) with extravascular hemolysis despite C5 inhibitor therapy, you likely qualify for Voydeya (danicopan) coverage through Blue Cross Blue Shield in New York. The fastest approval path requires: (1) Current C5 inhibitor therapy (Soliris/Ultomiris), (2)

How to Get Givlaari (Givosiran) Covered by Florida Blue Cross Blue Shield: Complete Forms, Appeals, and Approval Guide

Quick Answer: Getting Givlaari Covered by Florida Blue in 2024 Florida Blue requires prior authorization for Givlaari (givosiran) with specific medical criteria. Submit your request through Availity.com or call 1-877-719-2583. You'll need confirmed acute hepatic porphyria diagnosis with elevated PBG/ALA levels, genetic testing, and documented attack

How to Get Xenpozyme (olipudase alfa-rpcp) Covered by Blue Cross Blue Shield in Pennsylvania: Complete Coding, Appeals, and Authorization Guide

Answer Box: Getting Xenpozyme Covered in Pennsylvania Xenpozyme (olipudase alfa-rpcp) requires prior authorization from Blue Cross Blue Shield plans in Pennsylvania. Use ICD-10 codes E75.240 (type A), E75.241 (type B), or E75.244 (type A/B) for ASMD diagnosis. Submit PA with genetic confirmation, baseline organ assessments, and

How to Get Turalio (Pexidartinib) Covered by Blue Cross Blue Shield in Michigan: Complete PA Timeline & Appeal Guide

Answer Box: Getting Turalio Covered by Blue Cross Blue Shield in Michigan Blue Cross Blue Shield of Michigan requires prior authorization for Turalio (pexidartinib) to treat TGCT, with approval contingent on REMS enrollment, confirmed diagnosis, and surgical non-feasibility documentation. The fastest path: (1) Enroll all parties in REMS at turaliorems.

How to Get Synagis (Palivizumab) Covered by Blue Cross Blue Shield in North Carolina: Complete PA Guide and Appeals Process

Answer Box: Getting Synagis Covered by Blue Cross Blue Shield in North Carolina Synagis (palivizumab) requires prior authorization from Blue Cross Blue Shield of North Carolina for high-risk infants during RSV season (September-March). Submit the RSV Prophylaxis fax form with NICU records, cardiology/pulmonology consults, and gestational age documentation. If

How to Get Pemazyre (pemigatinib) Covered by Blue Cross Blue Shield in New Jersey: Prior Authorization Guide & Appeal Process

Quick Answer: Getting Pemazyre Covered in New Jersey Pemazyre (pemigatinib) requires prior authorization from Blue Cross Blue Shield in New Jersey for cholangiocarcinoma with FGFR2 fusion or myeloid/lymphoid neoplasms with FGFR1 rearrangement. Submit PA with FGFR testing results, oncologist attestation, and prior therapy documentation. If denied, file internal appeals

How to Get Humate-P Covered by Blue Cross Blue Shield in New Jersey: Complete Prior Authorization and Appeals Guide

Answer Box: Horizon Blue Cross Blue Shield of New Jersey requires prior authorization for Humate-P through their Medical Injectables Program. Submit via provider portal with hematologist documentation, VWF labs, and desmopressin trial results (if applicable). If denied, use New Jersey's IHCAP external review program managed by Maximus Federal