You may need drugs that require prior authorization. PATIENT INFORMATION PHYSICIAN INFORMATION Name Name ID number Specialty Date of birth Male … When this occurs, plans will have an alternative medication on their  (drug list) for a the medical condition that isn't covered for a particular drug.However, if your prescriber believes it’s medically necessary for you to be on that particular drug even though you don’t meet the prior authorization criteria, you or your prescriber can contact the plan to request an exception. Reviews are done to confirm the following:For more information about which services require prior plan approval and instructions on how to request prior review, select from the categories below:Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Prior authorization program guidelines: The prescribing physician can fax the applicable form to Blue MedicareRx for any exception request. Once a patient, or their physician, receives a written denial (coverage determination), they should submit a coverage determination request form asking for the drug to be covered.

You may need drugs that require prior authorization. Click the link for Medical Prior Authorization.

As an alternative, you can use this form to request authorization. © 2020 Blue Cross and Blue Shield of North Carolina. Prior plan approval.

This means before the plan will cover a particular drug, you must show the plan you meet certain criteria for you to have that particular drug. Note During the COVID-19 pandemic, Medicare Advantage Plans and Prescription Drug Plans may waive or relax prior authorization requirements.

®, SM Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Call Pharmacy Member Services, using the toll free number on the reverse side of their member ID card, to see if there are additional steps that need to be taken, depending on the particular pharmacy benefit plan. Ask how long it usually takes for the physician to complete the appropriate forms to initiate the prior authorization process. I want to make sure Medicare can give my personal health information to someone other than me (Authorization to Disclose Personal Health Information form/CMS-10106).

For more information, please see our Medicare Advantage Plans and Prescription Drug Plans may waive or relax prior authorization requirements.

Blue Cross NC is an abbreviation for Blue Cross and Blue Shield of North Carolina. Contact your plan about its prior authorization requirements, and talk with your prescriber.Plans may also use prior authorization when they cover a medication for certain medical conditions, but not all medical conditions for which a drug is approved. Please complete this form and submit via fax to 1-866-392-6465.

Plans also do this to be sure these drugs are used correctly.

Prior plan approval (also referred to as prior review, prior authorization, prospective review or certification) is the process by which Blue Medicare HMO & Blue Medicare PPO reviews the provision of certain behavioral health, medical services and medications against healthcare management guidelines prior to the services being provided. To get the Medicare form you need, find the situation that applies to you. Contact us at: Toll Free: 1 … Enrollment in Blue Cross and Blue Shield of North Carolina depends on contract renewal. Get forms in alternate formats.

Blue Cross and Blue Shield of North Carolina is an HMO, PPO, and PDP plan with a Medicare contract. Check with your plan for more information.A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Prior plan approval (also referred to as prior review, prior authorization, prospective review or certification) is the process by which Blue Medicare HMO & Blue Medicare PPO reviews the provision of certain behavioral health, medical services and medications against healthcare management guidelines prior to the services being provided. Inpatient admissions, services and procedures received on an outpatient basis, such as home health services, and prescription medications may be subject to prior plan approval.

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