Topic

Synagis (palivizumab)

A collection of 30 issues

How to Get Synagis (Palivizumab) Covered by Humana in Washington: Complete Authorization & Appeals Guide

Answer Box: Getting Synagis Covered by Humana in Washington Synagis (palivizumab) requires prior authorization from Humana for high-risk pediatric patients during RSV season. Your fastest path: 1) Confirm your child meets AAP high-risk criteria (≤35 weeks gestation, chronic lung disease, or congenital heart disease), 2) Have your pediatrician submit Humana&

How to Get Synagis (Palivizumab) Covered by Blue Cross Blue Shield in Georgia: Timeline, Forms & Appeals Guide

Answer Box: Getting Synagis Covered in Georgia Blue Cross Blue Shield Georgia (Anthem) requires prior authorization for Synagis (palivizumab) with decisions typically within 15 business days (72 hours for urgent cases). High-risk infants under 24 months with conditions like prematurity, chronic lung disease, or congenital heart disease qualify. First step

The Requirements Checklist to Get Synagis (Palivizumab) Covered by Blue Cross Blue Shield in California: Forms, Timelines, and Appeal Strategies

Answer Box: Getting Synagis Coverage in California Synagis (palivizumab) requires prior authorization from Blue Cross Blue Shield plans in California. The fastest path to approval: (1) Submit PA request through Blue Shield's Provider Connection portal with complete clinical documentation showing high-risk RSV criteria, (2) Include cardiology/pulmonology notes

Do You Qualify for Synagis (Palivizumab) Coverage by Blue Cross Blue Shield of Texas? Decision Tree & Next Steps

Answer Box: Quick Qualification Check Yes, you likely qualify for Synagis coverage if your child: is under 12 months old at RSV season start, born ≤29 weeks gestation OR has chronic lung disease/significant heart disease, and hasn't received RSV vaccine/antibody this season. Fastest path: Submit Texas

How to Get Synagis (Palivizumab) Covered by Humana in New Jersey: Complete PA Guide and Appeals Process

Quick Answer: Synagis (palivizumab) requires prior authorization from Humana in New Jersey. High-risk infants under 12 months with specific conditions (prematurity ≤35 weeks, chronic lung disease, congenital heart disease) are eligible. Submit Humana's Antiviral Monoclonal Antibodies PA form with clinical documentation. If denied, you have 65 days to

How to Get Synagis (Palivizumab) Covered by Blue Cross Blue Shield of Michigan: Complete Forms, Appeals & Contact Guide

Answer Box: To get Synagis (palivizumab) covered by Blue Cross Blue Shield of Michigan, you need prior authorization using their Medication Authorization Request Form. Submit via fax (1-877-325-5979) or Availity portal with clinical documentation proving high-risk RSV status per AAP guidelines. If denied, file internal appeal within 180 days, then

How to Get Synagis (Palivizumab) Covered by UnitedHealthcare in Pennsylvania: Complete Appeals Guide with Templates

Quick Answer: Getting Synagis Covered by UnitedHealthcare in Pennsylvania UnitedHealthcare requires prior authorization for Synagis (palivizumab) in Pennsylvania, with strict eligibility limited to high-risk infants under 24 months. You'll need specialist documentation proving your child meets specific criteria (premature with chronic lung disease, significant congenital heart disease, or

How Long Does It Take to Get Synagis (Palivizumab) Approved by UnitedHealthcare in California? Complete Timeline Guide

Answer Box: Synagis Approval Timeline with UnitedHealthcare in California UnitedHealthcare requires prior authorization for Synagis (palivizumab) in California, with approval typically taking 1-7 business days for complete submissions. OptumRx's automated PreCheck system can approve eligible cases in approximately 29 seconds when all criteria are met. The fastest path:

How to Get Synagis (Palivizumab) Covered by Horizon Blue Cross Blue Shield in New Jersey: Complete Guide to Prior Authorization, Appeals, and External Review

Answer Box: Getting Synagis Covered in New Jersey To get Synagis (palivizumab) covered by Horizon Blue Cross Blue Shield in New Jersey, you need prior authorization through their specialty pharmacy network. Start by having your pediatrician submit a PA request with current cardiology or pulmonology documentation proving high-risk status. If

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