Glossary of Terms – MyBlue Customer eService
PRECERTIFICATION PENALTY We will reduce your benefit by $500 if no one (you, your physician or the hospital) contacts us to obtain precertification of inpatient hospital services, when required. PROVIDER The hospital, health care facility, physician or other
Services That Require Precertification
Federal Employee Program (FEP) Standard Option (enrollment code 104, 105, and 106) Basic Option (enrollment code 111, 112, and 113) FEP Blue Focus (enrollment code 131, 132, and 133) Criteria Used in Precertification Decisions Evidence-based
Precertification requirements
Fax all requests for services requiring precertification to: Inpatient: 1-877-434-7578 Outpatient: 1-800-505-1193 Services billed with the following revenue codes always require precertification: 0240–0249 all-inclusive ancillary psychiatric 0901, 0905–0907, 0913 and
Federal Employee Program (FEP)
To get precertification before an inpatient hospital admission, please call the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii. Behavioral Health Admissions Prior approval is no longer required for outpatient professional or outpatient facility care for mental health and substance abuse treatment.
Federal Employee Program
The Blue Cross and Blue Shield Service Benefit Plan, also known as the BCBS Federal Employee Program® (BCBS FEP®), has been part of the Federal Employees Health Benefits Program (FEHBP) since its inception in 1960. It covers about 5.3 million federal
Preauthorization Information for Providers
In-state providers must submit requests through NaviNet. Out-of-state providers can also create a NaviNet account to submit preauthorizations, however, you have the option to go through the manual process of submitting by fax or phone. Please use the Preauthorization Request Form or call the customer service phone number on the back of the member’s BCBSNE ID card.
Precertification Request Form
· PDF 檔案Precertification Request Form – Confidential – Date Submitted: _____ Complete this form to request precertification for a specific procedure/service. If the determination of this review will influence the decision to proceed with treatment, we
2021 FEP Prior Approval Drug List
· PDF 檔案2021 FEP Prior Approval Drug List Rev. 2 28.21 Delatestryl Demerol Solution 0.1% Demser Depo-Testosterone Derma-smooth /FS body oil 0.01%/ Derma-smooth /FS scalp oil 0.01% (fluocinolone acetonide)+ Dermatop Cream, Ointment 0.1
Provider Communications
To request precertification and engagement in Integrated Health Management (360 Health), facilities are encouraged to utilize the self-service tools available through the Availity portal or by using the available fax forms located on the BCBSM.com website.
Empire BCBS Phone Number and Claim Address
The BCBS Federal Employee Program ID begins with an “R” followed by eight digits. A 3 digit enrollment code is located on the front of the card. The enrollment codes specify which option the govt employee elected when enrolled in the FEP program and should be entered as the group ID number BCBS claims.For example See Below
Prior Authorization/Precertification Request
· PDF 檔案Blue Cross and Blue Shield of Minnesota and Blue Plus Prior Authorization/Precertification Request bluecrossmn.com Blue Cross® and Blue Shield® of Minnesota and
Federal Employee Program (FEP)
To get precertification before an inpatient hospital admission, please call the Federal Employee Program (FEP) of Blue Cross Blue Shield of Hawaii. Behavioral Health Admissions Prior approval is no longer required for outpatient professional or outpatient facility care for mental health and substance abuse treatment.
Bcbs Federal Employee Prior Auth Form
· PDF 檔案Download Bcbs Federal Employee Prior Auth Form pdf. Download Bcbs Federal Employee Prior Auth Form doc. Open in accordance employee prior to medical and blue shield symbols are responsible to help you can easily view and blue shield association of
Medical Policy Disclaimer
To access Blue Cross Blue Shield of North Dakota medical policies, health care providers will need to accept the BCBSND medical policy disclaimer. BCBSND has developed medical policies that serve as one of the sets of guidelines for coverage decisions.
Prior Authorizations
3. Review your request status/decision online Once a request is submitted, you can visit HealtheNet to check the status of a prior authorization. For pharmacy, call customer service for pharmacy benefit drugs. Call Provider Services for medical benefit drugs (customer service representatives can also transfer to the correct department for member-friendly experience if needed).
Standard Authorization and Certification Requirements
· PDF 檔案Standard Authorization and Certification Requirements The following provides information on standard services that routinely require admission certification, authorization, or notification for Blue Cross and Blue Shield of Florida, Inc. (BCBSF) and Health Options, Inc
Prior Authorization
Check First! Medical and Pharmacy Services that Need Prior Authorization As part of your Florida Blue health coverage, we provide services to help you save money by avoiding unnecessary costs. When you and your doctor are making decisions about your health