Topic

Pennsylvania

A collection of 499 issues

Coding That Helps Get Synagis (palivizumab) Approved in Pennsylvania with Blue Cross Blue Shield (ICD-10, HCPCS/J-Code, NDC)

Answer Box: Get Your Synagis Coding Right the First Time Getting Synagis (palivizumab) approved by Blue Cross Blue Shield in Pennsylvania requires precise coding. Use HCPCS code 90378 (50 mg units), weight-based dosing at 15 mg/kg monthly, and supporting ICD-10 codes like P07.3X (premature birth) or Q24.9

Work With Your Doctor to Get Mycapssa (Octreotide) Approved by UnitedHealthcare in Pennsylvania: Complete Provider Collaboration Guide

Answer Box: Getting Mycapssa Approved by UnitedHealthcare in Pennsylvania Fastest path to approval: Document prior response to injectable octreotide or lanreotide, then work with your endocrinologist to submit a complete prior authorization showing step therapy compliance. If denied, Pennsylvania's new external review program has a 50% overturn rate

Resources to Get Filspari (sparsentan) Approved with UnitedHealthcare in Pennsylvania: Forms, Portals & Contacts

Quick Start: Get Filspari Covered by UnitedHealthcare in Pennsylvania Fastest Path: Submit prior authorization through UnitedHealthcare's provider portal at uhcprovider.com with complete IgA nephropathy documentation including renal biopsy, eGFR ≥30 mL/min/1.73 m², and evidence of ACE inhibitor or ARB therapy. Most authorizations complete within

How to Get Ruconest (C1 Esterase Inhibitor) Covered by Blue Cross Blue Shield in Pennsylvania: Appeals Guide 2025

Quick Answer: Getting Ruconest Covered in Pennsylvania Blue Cross Blue Shield in Pennsylvania typically requires prior authorization for Ruconest (C1 esterase inhibitor [recombinant]) used to treat hereditary angioedema (HAE) acute attacks. The fastest path to approval: Submit a complete prior authorization with documented HAE diagnosis, attack history, and clinical justification.

Myths vs. Facts: Getting Sumavel DosePro Covered by UnitedHealthcare in Pennsylvania (2025 Guide)

Quick Answer: Getting Sumavel DosePro Covered by UnitedHealthcare in Pennsylvania Note: Sumavel DosePro has been discontinued by the manufacturer. For current needle-free sumatriptan options, UnitedHealthcare OptumRx requires prior authorization and step therapy—you must try oral triptans first unless contraindicated. In Pennsylvania, if denied, you can appeal through the state&

Renewing Dojolvi (Triheptanoin) Approval with Blue Cross Blue Shield in Pennsylvania: Complete Timeline and Documentation Guide

Answer Box: Renewing Dojolvi (triheptanoin) with Blue Cross Blue Shield in Pennsylvania requires submitting updated clinical documentation 60 days before your current authorization expires. You'll need molecular confirmation of LC-FAOD, specialist oversight, proof of clinical benefit, and a medical necessity letter. If denied, Pennsylvania's new external

Coding That Helps Get StrataGraft Approved in Pennsylvania with Blue Cross Blue Shield (ICD-10, HCPCS J7353, NDC)

Quick Answer: StrataGraft requires prior authorization from Blue Cross Blue Shield in Pennsylvania, billed under HCPCS code J7353 as a medical benefit (not pharmacy). Use ICD-10 codes T20-T25 for burn location plus T31 for body surface area. Calculate units as actual cm² treated (each unit = 100 cm²). Submit PA with

How to Get Skyrizi (risankizumab) Covered by Cigna in Pennsylvania: Prior Authorization, Appeals, and Alternative Options

Quick Answer: Getting Skyrizi (risankizumab) Covered by Cigna in Pennsylvania Skyrizi is excluded from the 2024 Express Scripts National Preferred Formulary, which most Cigna commercial plans follow. To get coverage in Pennsylvania, you'll need a formulary exception with documented failure of preferred alternatives like Humira, Cosentyx, or Tremfya.

The Requirements Checklist to Get Nucala (Mepolizumab) Covered by Aetna (CVS Health) in Pennsylvania

Answer Box: Getting Nucala (Mepolizumab) Covered by Aetna (CVS Health) in Pennsylvania Quick Path to Approval: Nucala requires prior authorization from Aetna CVS Health in Pennsylvania. You'll need a specialist (allergist/immunologist or pulmonologist), documented blood eosinophil count ≥150 cells/µL, and proof of failed high-dose inhaled corticosteroids

Getting Tysabri (Natalizumab) Covered by Aetna CVS Health in Pennsylvania: Complete Coverage Guide

Answer Box: Fastest Path to Approval Aetna CVS Health requires prior authorization for Tysabri (natalizumab) in Pennsylvania. You'll need: neurologist prescription, TOUCH program enrollment, JCV antibody testing, recent MRI, and documentation of prior treatment failures. Standard approval takes 30-45 days; expedited reviews complete within 72 hours for urgent