Download
1 / 28
280 likes | 521 Views
Specialty Pharmacy Submission. BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association
E N D
Specialty Pharmacy Submission BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association BlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association, an Association of Independent BlueCross and BlueShield Plans CPT® is a registered trademark of the American Medical Association This document has been classified as public information.
Specialty Pharmacy Submission Enter user ID and password to log on to the secure area of bcbst.com.
Authorization Submission SpecialtyPharmacy Submission Select “Commercial/BlueAdvantage/BlueCare®/TennCareSelect” to begin the authorization submission process. 3
Authorization Submission SpecialtyPharmacy Submission Select “Commercial/BlueAdvantage/BlueCare®/TennCareSelect” to begin the authorization submission process. 4
Specialty Pharmacy Submission Special Pharmacy authorizations can be submitted online under “Authorization/Advance Determination Submission.”
Specialty Pharmacy Submission Select “Specialty Pharmacy” to begin the authorization process.
Specialty Pharmacy Submission Specialty Pharmacy Authorizations cannot be back-dated. Enter the date of service, then select a member by entering the appropriate member ID number without the three-letter prefix, then select “Search.”
Specialty Pharmacy Submission Highlight correct member and click. Member information will auto-populate into the correct fields.
Specialty Pharmacy Submission Select the appropriate Specialty Pharmacy Procedure Codefrom the drop-down menu.
Specialty Pharmacy Submission Enter the Requesting Provider ID number or search for it. Servicing Provider ID is not required if it is the sameas the requesting provider.
Specialty Pharmacy Submission Search for Providers by entering ID, name or location then clicking “Search.” A list of possible matches will be created. Click the correct provider to auto-populate the authorization request.
Specialty Pharmacy Submission • Reminder: • All fields with an asterisk • must be completed. • ICD-9 codes should omit • decimals. • Dates are in MM/DD/YYYY • format.
Specialty Pharmacy Submission Select the appropriate options from drop-down menus.
Specialty Pharmacy Submission “Apply BlueCross BlueShield of Tennessee Medical Policy Criteria” is selected by default and is necessary to obtain immediateonline authorization.
Specialty Pharmacy Submission If BlueCross BlueShield of Tennessee Medical Policy Criteria are not applied, supporting information is required here andthe authorization will be pendedfor review. When this screen is completed, choose “Continue.”
Specialty Pharmacy Submission When the screen is completed, a summary screen will be shown.Please review the information for accuracy and provider network status.
Specialty Pharmacy Submission If changes are needed, click “Back” to go back and correct the information. When all information is correct, click “Continue.”
Specialty Pharmacy Submission Apply BlueCross BlueShield of Tennessee Medical Policy Criteria. The system will show the guideline associated with the Specialty Pharmacy code selected. If the guideline is appropriate, click the box next to it and select “Continue.”
Specialty Pharmacy Submission It is also possible to search for a guideline by selecting “Show All Guidelines” and “Search Guidelines.”
Specialty Pharmacy Submission Click “Show All Guidelines” to bring up a drill-down menu. Click on “+” to drill down to the appropriate guideline, then select the specific Specialty Drug.
Specialty Pharmacy Submission The “Search Guidelines” option will bring up a search screen and can be searched by ICD-9 Code, CPT® Code or guideline description. This example is being searched by description.Select “Search” after entering code or description.
Specialty Pharmacy Submission Select the appropriate guideline and click “Continue.”
Specialty Pharmacy Submission Select all that apply, then click “Continue.”
Specialty Pharmacy Submission A summary screen will show selected criteria.
Specialty Pharmacy Submission If the clinical information submitted meets criteria, an authorizationnumber will be given. Print this page for your records.
Specialty Pharmacy Submission If clinical information does not meet guidelines, submit any additional clinical information to be considered for review, then click “Finish.”
Specialty Pharmacy Submission Authorizations that are pended will generate a confirmation number. The confirmation number may be used to check status of the request online. A nurse will call with the decision. The Gold Card network (Blue Network K) cannot be used for Specialty Pharmacy.
