Topic

Ohio

A collection of 480 issues

Coding That Helps Get HyperHEP (Hepatitis B Immune Globulin) Approved by Blue Cross Blue Shield in Ohio: ICD-10, HCPCS, and Medical Necessity

Answer Box: Getting HyperHEP Covered in Ohio HyperHEP (hepatitis B immune globulin) requires prior authorization from Blue Cross Blue Shield in Ohio under the medical benefit. Use HCPCS code 90371 for billing, pair with exposure-specific ICD-10 codes (B19.1 for unspecified HBV exposure), and document clear medical necessity within CDC

How to Get Carbaglu (Carglumic Acid) Covered by Aetna CVS Health in Ohio: ICD-10, HCPCS, and Prior Authorization Guide

Answer Box: Getting Carbaglu Covered by Aetna CVS Health in Ohio Fastest path to approval: Submit prior authorization with genetic/biochemical confirmation of NAGS deficiency (ICD-10: E72.20), elevated ammonia labs, and specialist documentation. Use HCPCS J7518 for medical benefit billing. If denied, file internal appeal within 65 days, then

Renewing Natpara (Parathyroid Hormone) Coverage with UnitedHealthcare in Ohio: Complete 2025 Guide

Answer Box: Renewing Natpara Coverage in Ohio UnitedHealthcare requires annual reauthorization for Natpara (parathyroid hormone) with specific documentation. Start your renewal 60-90 days before expiration. You'll need: recent serum calcium labs (8.0-8.5 mg/dL target), continued calcium supplementation proof, and specialist prescription from endocrinologist/nephrologist. Submit

If Nucala Isn't Approved by UnitedHealthcare in Ohio: Formulary Alternatives & Exception Paths

Quick Answer: Nucala Alternatives & Exception Paths If UnitedHealthcare denies Nucala (mepolizumab) coverage in Ohio, you have two main options: try formulary-preferred alternatives like benralizumab or dupilumab, or request an exception for Nucala with medical necessity documentation. First step today: Call UnitedHealthcare member services to confirm your plan's

How to Get Krystexxa (Pegloticase) Covered by Aetna CVS Health in Ohio: Complete Prior Authorization Guide (2025)

Answer Box: Getting Krystexxa Approved by Aetna CVS Health in Ohio Fastest path to approval: Submit prior authorization with complete documentation showing failure of both allopurinol and febuxostat, normal G6PD test results, and rheumatologist prescription. Aetna typically decides within 72 hours of receiving complete documentation. If denied, you have 180

How to Get Jynarque (Tolvaptan) Covered by UnitedHealthcare in Ohio: Complete PA Guide with Appeal Scripts

Quick Answer: Getting Jynarque Covered by UnitedHealthcare in Ohio UnitedHealthcare requires prior authorization for Jynarque (tolvaptan) but has no step therapy requirement in 2024. To get approved: 1) Document ADPKD with rapid progression (≥2.5 mL/min/1.73m²/year eGFR decline over 4+ years), 2) Enroll in FDA REMS

How to Get Somatuline Depot (Lanreotide) Covered by Cigna in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Somatuline Depot Covered by Cigna in Ohio Cigna requires prior authorization for Somatuline Depot (lanreotide), typically places it on Tier 4/5 specialty formulary, and mandates step therapy with octreotide (Sandostatin LAR) first. In Ohio, if denied, you have 180 days to appeal internally, then 180 days

Get Trikafta Covered by UnitedHealthcare in Ohio: Prior Authorization, Appeals & State Protections

Answer Box: Getting Trikafta Covered by UnitedHealthcare in Ohio Trikafta requires prior authorization from UnitedHealthcare in Ohio with step therapy requirements. The fastest path to approval: (1) Submit PA request through OptumRx portal with genetic testing confirming F508del mutation, (2) Request step therapy exception if you've failed other

How to Get Dojolvi (Triheptanoin) Covered by Cigna in Ohio: Complete Coding, Appeals & Timeline Guide

Answer Box: Getting Dojolvi (Triheptanoin) Covered by Cigna in Ohio Eligibility: Cigna covers Dojolvi for molecularly confirmed long-chain fatty acid oxidation disorders (LC-FAOD) with prior authorization. Fastest path: Submit PA through Express Scripts with genetic testing, specialist diet plan, and MCT oil discontinuation documentation. First step today: Contact your metabolic

Getting Rapivab (Peramivir) Covered by Humana in Ohio: Complete Prior Authorization and Appeals Guide

Answer Box: Quick Path to Approval Rapivab (peramivir) requires prior authorization from Humana in Ohio. Start within 48 hours of flu symptoms for best approval odds. Submit PA request through Humana's provider portal or fax 888-285-1114 with: symptom onset documentation (≤48 hours), positive flu test, and clinical justification