Topic

Insurance Approval

A collection of 2896 issues

Getting Orfadin (Nitisinone) Covered by Cigna in New York: Coding, Appeals & Prior Authorization Guide

Answer Box: Getting Orfadin (Nitisinone) Covered by Cigna in New York Orfadin (nitisinone) for hereditary tyrosinemia type 1 requires Cigna prior authorization using ICD-10 code E70.29 and HCPCS J8499. Key steps: 1) Confirm HT-1 diagnosis with elevated succinylacetone levels, 2) Submit PA with specialist documentation and dietary management plan,

How to Get Orkambi (lumacaftor/ivacaftor) Covered by Aetna CVS Health in Florida: Complete Approval Guide

Quick Answer: Getting Orkambi Covered by Aetna CVS Health in Florida Aetna CVS Health requires prior authorization for Orkambi (lumacaftor/ivacaftor) in Florida. Your fastest path to approval: (1) Confirm F508del homozygous mutation documentation, (2) Submit complete prior authorization via Availity provider portal with CF diagnosis and failed therapy history,

How to Get Darzalex Covered by Humana in New York: Step Therapy Laws, Appeals Process, and Prior Authorization Guide

Answer Box: Getting Darzalex Covered by Humana in New York Darzalex (daratumumab) requires prior authorization from Humana Medicare Advantage plans in New York. If denied, you can appeal internally and request external review through the New York Department of Financial Services (DFS) within four months. New York's step

How to Get Soliris (Eculizumab) Covered by Blue Cross Blue Shield in New Jersey: Complete Timeline & Appeal Guide

Answer Box: Getting Soliris Covered by BCBS in New Jersey Horizon Blue Cross Blue Shield of New Jersey requires prior authorization for Soliris (eculizumab) with approval typically taking 5-15 days for standard requests. Your fastest path: (1) Ensure meningococcal vaccination is current, (2) Have your doctor submit complete PA documentation

Getting Kuvan (Sapropterin) Covered by Humana in North Carolina: Complete Coding & Appeals Guide

Quick Answer: Your Path to Kuvan Coverage Kuvan (sapropterin) requires prior authorization from Humana, billed under Medicare Part D using NDC codes (not J-codes). Key steps: 1) Ensure correct ICD-10 coding (E70.0 for classical PKU, E70.1 for other hyperphenylalaninemia), 2) Submit weight-based dosing documentation with specialist confirmation, 3)

How to Get Enbrel (etanercept) Covered by Blue Cross Blue Shield in New York: Complete Requirements Guide

Answer Box: Getting Enbrel Covered by Blue Cross Blue Shield in New York Blue Cross Blue Shield plans in New York require prior authorization for Enbrel (etanercept) with step therapy requirements favoring biosimilars first. Your fastest path to approval: 1) Have your rheumatologist or dermatologist document failed trials of preferred

Getting Pombiliti (cipaglucosidase alfa-atga) Covered by Cigna in Ohio: Prior Authorization, Appeals, and Cost-Saving Strategies

Quick Answer: Your Path to Pombiliti Coverage Cigna requires prior authorization for Pombiliti (cipaglucosidase alfa-atga) in Ohio. The fastest path: 1) Have your doctor complete Cigna's PA form with evidence of late-onset Pompe disease diagnosis and ERT failure, 2) Submit via fax (855-840-1678) or through Accredo specialty pharmacy,

Get Arikayce Covered by Cigna in New York: Complete Guide to Prior Authorization and Appeals

Answer Box: Getting Arikayce Covered by Cigna in New York Eligibility: Adults with refractory MAC lung disease who remain culture-positive after 6+ months of standard therapy. Fastest path: Your pulmonologist submits prior authorization to Cigna with documented treatment failure and culture results. Start today: Gather your sputum culture timeline, medication

How to Get Trikafta Covered by Aetna CVS Health in Ohio: Prior Authorization Forms, Appeal Process & Alternatives

Answer Box: Getting Trikafta Covered by Aetna CVS Health in Ohio Fastest Path: Aetna CVS Health covers Trikafta with prior authorization requiring CFTR genetic testing showing ≥1 F508del mutation, baseline labs, and CF specialist prescription. Submit PA via fax (1-888-267-3277) or phone (1-855-240-0535). If denied, you have 180 days to

How to Get Arikayce Covered by Humana in California: Prior Authorization Guide and Appeal Process

Quick Answer: Getting Arikayce Covered by Humana in California Humana requires prior authorization for Arikayce (amikacin liposome inhalation) with strict documentation of refractory MAC lung disease. Your fastest path to approval: 1) Gather 6+ months of failed standard therapy records, 2) Submit PA request with detailed medical necessity letter through