Topic

Florida

A collection of 395 issues

ICD-10 Codes and Billing Guide: Getting Xenpozyme Covered by UnitedHealthcare in Florida

Answer Box: Getting Xenpozyme Covered by UnitedHealthcare in Florida Quick Path to Approval: Xenpozyme requires prior authorization through UnitedHealthcare with specific ICD-10 codes (E75.240-E75.244), genetic testing confirmation, and medical benefit billing. Submit via OptumRx at 1-833-547-2030 with complete clinical documentation including ASMD diagnosis confirmation, baseline spleen imaging, and

Myths vs. Facts: Getting Strensiq (asfotase alfa) Covered by Blue Cross Blue Shield in Florida

Answer Box: Getting Strensiq Covered in Florida Eligibility: Blue Cross Blue Shield Florida covers Strensiq for perinatal/infantile-onset or juvenile-onset hypophosphatasia with disease onset before age 12. Fastest path: Have your endocrinologist or bone specialist submit prior authorization with genetic testing, low ALP levels, radiographic evidence, and elevated PLP levels.

How to Get Hemgenix (Etranacogene Dezaparvovec) Covered by Florida Blue Cross Blue Shield: Complete Approval Guide

Answer Box: Getting Hemgenix Covered by Florida Blue Cross Blue Shield Hemgenix requires prior authorization from Florida Blue Cross Blue Shield. To qualify, you must be an adult male with severe/moderately severe Hemophilia B (≤2% Factor IX activity), currently on Factor IX prophylaxis or with serious bleeding history, negative

How to Get Haegarda (C1-Esterase Inhibitor) Covered by Cigna in Florida: Complete Appeals Guide with Forms and Timelines

Quick Answer: Getting Haegarda Covered by Cigna in Florida Fastest path to approval: Submit prior authorization through your specialty pharmacy with confirmed HAE diagnosis, attack frequency documentation, and failure/intolerance of preferred alternatives. Timeline: 72 hours for standard review, 24 hours expedited. First step today: Contact your prescribing physician to

How to Get Evrysdi (Risdiplam) Approved by Cigna in Florida: Timeline, Forms & Appeal Guide

Answer Box: Getting Evrysdi Approved by Cigna in Florida Timeline: Cigna typically responds to Evrysdi prior authorization requests within 5 business days (expedited in 24-72 hours for urgent cases). Requirements: Genetic testing confirming SMA diagnosis, neurologist prescription, baseline motor assessment, and weight-based dosing documentation. First step: Have your neurologist complete

How to Get Kesimpta (ofatumumab) Covered by Blue Cross Blue Shield in Florida: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Kesimpta Covered by Blue Cross Blue Shield in Florida Eligibility: Adults with relapsing forms of MS (CIS, RRMS, active SPMS) can get Kesimpta covered through Florida Blue's prior authorization process. Fastest Path: Your neurologist submits a PA request with MS diagnosis confirmation, hepatitis B screening

Do You Qualify for Rebif Coverage by UnitedHealthcare in Florida? Decision Tree & Next Steps

Quick Answer: Your Path to Rebif Coverage Yes, you can get Rebif (interferon beta-1a) covered by UnitedHealthcare in Florida if you have a confirmed relapsing MS diagnosis with documented disease activity. The fastest path: have your neurologist submit prior authorization through the UnitedHealthcare Provider Portal with recent MRI showing new

How to Get Spinraza (Nusinersen) Covered by Blue Cross Blue Shield in Florida: Complete Coverage Guide

Quick Answer: Getting Spinraza Covered by Florida Blue Cross Blue Shield Eligibility: Confirmed 5q SMA diagnosis with genetic testing, baseline motor function assessment (HFMSE, CHOP-INTEND, or RULM), and specialist prescription. Fastest path: Submit prior authorization through Florida Blue provider portal with complete documentation package. Start today: Contact your neurologist to

Getting Tecentriq (Atezolizumab) Covered by Cigna in Florida: Complete Appeals Guide with Forms and Timelines

Answer Box: Quick Path to Tecentriq Coverage For Cigna Medicare Advantage members in Florida: Tecentriq requires no prior authorization. For other Cigna plans, submit PA through Accredo specialty pharmacy with PD-L1 testing results ≥1% (adjuvant NSCLC) or ≥50% TC/≥10% IC (metastatic). If denied, file internal appeal within 180 days,

How to Get Kalydeco (Ivacaftor) Covered by Cigna in Florida: Complete Coding, Prior Authorization & Appeals Guide

Quick Answer: Kalydeco requires prior authorization from Cigna with documented CFTR mutation testing (G551D, R117H, or other responsive mutations) and ICD-10 code E84.0-E84.9. Your CF specialist must submit genetic testing results, medical necessity documentation, and complete prior authorization within 72 hours for standard review. If denied, Florida residents