Topic

North Carolina

A collection of 451 issues

Work With Your Doctor to Get Defitelio (Defibrotide) Approved by Aetna (CVS Health) in North Carolina: Provider Partnership Guide

Answer Box: Getting Defitelio Covered by Aetna in North Carolina Who's eligible: Patients with hepatic veno-occlusive disease (VOD) with organ dysfunction after stem cell transplant meeting FDA criteria. Fastest approval path: Your transplant specialist submits prior authorization with complete clinical documentation showing VOD diagnosis and organ dysfunction. Start

Getting iLink® Corneal Cross-Linking Covered by UnitedHealthcare in North Carolina: Complete Appeals Guide

Quick Answer: Your Path to Coverage UnitedHealthcare commercial plans in North Carolina cover iLink® corneal cross-linking for progressive keratoconus when medical necessity criteria are met. Start with a prior authorization request through your ophthalmologist, including corneal topography showing progression and documentation of failed conservative treatments. If denied, you have 180

Renewing Isturisa (Osilodrostat) Approval with Humana in North Carolina: Complete Preparation Guide

Answer Box: Renewing Your Isturisa Coverage with Humana in North Carolina Humana requires prior authorization renewal for Isturisa (osilodrostat) with updated clinical documentation confirming ongoing medical necessity. Start the renewal process 30-45 days before your current authorization expires to avoid treatment interruptions. Submit renewal requests through Humana's electronic

Renewing Humate-P Approval with Cigna in North Carolina: 2024 Requirements, Timelines, and Appeal Scripts

Answer Box: Humate-P Renewal with Cigna in North Carolina Cigna requires prior authorization renewal for Humate-P every 9 months (changed from 6 months in December 2024). Start your renewal 30 days early to avoid lapses. Required documents: updated clinical notes, lab results (FVIII:C and VWF:RCo levels), prescriber attestation,

Work With Your Doctor to Get Trikafta Covered by Blue Cross Blue Shield in North Carolina: Complete Provider Collaboration Guide

Answer Box: Getting Trikafta Approved in North Carolina Your fastest path to Trikafta approval: Work directly with your CF specialist to submit a complete prior authorization with CFTR genetic testing results, baseline liver function tests, and a detailed medical necessity letter. Blue Cross Blue Shield of North Carolina requires these

How to Get Taltz (ixekizumab) Covered by UnitedHealthcare in North Carolina: Complete Timeline and Appeals Guide

Answer Box: Getting Taltz Covered by UnitedHealthcare in North Carolina UnitedHealthcare requires prior authorization for Taltz (ixekizumab) with step therapy documentation showing failure of preferred biologics like adalimumab or etanercept. Standard approval takes 15 business days; expedited reviews complete within 72 hours. If denied, you have 180 days for internal

How to Get Crysvita (burosumab) Covered by Cigna in North Carolina: Appeals Guide & Templates

Answer Box: Getting Crysvita (burosumab) Covered by Cigna in North Carolina For Medicare Advantage: Crysvita requires no prior authorization when billed under Medical Oncology (HCPCS J0584). For Commercial plans: Prior authorization is required with specific XLH or TIO diagnosis documentation, phosphate monitoring plan, and specialist oversight. If denied, appeal internally

How to Get Kineret (anakinra) Covered by Aetna CVS Health in North Carolina: Complete Guide with Forms, Timelines, and Appeal Scripts

Answer Box: Getting Kineret Approved in North Carolina Aetna CVS Health requires prior authorization for Kineret (anakinra) in North Carolina. Start by submitting a PA request through the Availity provider portal with documentation of failed DMARDs/biologics. If denied, you have 180 days to appeal internally, then 120 days for

Get Imbruvica (Ibrutinib) Covered by Humana in North Carolina: Complete Guide to Prior Authorization and Appeals

Answer Box: Imbruvica (ibrutinib) is covered by Humana Medicare Advantage in North Carolina but requires prior authorization. Your fastest path to approval: (1) Have your oncologist submit PA documentation via fax to 1-877-486-2621 with complete diagnostic records, (2) Include pathology confirming CLL/SLL/Waldenström's diagnosis, and (3) Document

How to Get Tremfya (guselkumab) Covered by Cigna in North Carolina: Renewal Guide, Appeals, and Timeline

Answer Box: Renewing Tremfya (guselkumab) with Cigna in North Carolina Cigna requires documented clinical benefit after 6+ months of Tremfya use for renewal authorization, typically approved for 12 months. Submit renewal requests 30-60 days before expiration with objective disease measures (PASI score for psoriasis, joint counts for psoriatic arthritis) and