blue cross blue shield medical necessity criteria allegra

These guidelines address the medical necessity of existing, generally accepted services, technologies and drugs. View Medical Policies on MedPolicy Blue » Assistant Surgery Guidelines BCBSNE follows CMS’s Post-Op and Assistant Surgery Policy. The new program is designed to promote optimal support for our members' cancer care needs, while simultaneously reducing the costs for managing one of the most complex, expensive and prevalent diseases members can encounter. More specific than guidelines, Pathway regimens identify treatments selected based on clinical effectiveness, favorable toxicity profiles, and cost. Medical Policies. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. If the request does not meet established criteria guidelines, it will then be referred to the licensed physician with the appropriate clinical expertise for review. Additionally, a policy for participation in clinical trials is available as an administrative guideline.In certain markets, Blue Cross and Blue Shield of North Carolina, delegates the Utilization Management for PRIOR REVIEW and CERTIFICATION of specific services or benefits to other companies not associated with BCBSNC. This document contains the fulllist of services, procedures, prescription drugs, and medical devices1 Guidelines applied are based upon the member's product. Each individual's unique, clinical circumstances may be considered in light of current scientific literature. These companies are Independent Licensees of the Blue Cross and Blue Shield Association.Florida Blue and Florida Blue HMO do not discriminate on the basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of their plans, including enrollment and benefit determinations. The following information describes the Medical Necessity care guidelines utilized by Blue Cross and Blue Shield of Illinois (BCBSIL) for its group, retail and government products. Click on the link below to access our Medical Policies (Medical Coverage Guidelines).Please have your patient refer to his or her contract, Evidence of Coverage, member handbook, certificate of coverage, or endorsement or rider, if applicable, to determine coverage. The Program includes online access for oncologists, urologists, and hematologists to decision support tools for selecting cancer treatment regimens, which are consistent with current evidence and consensus guidelines. Prior Authorization is required for various services, procedures, prescription drugs, and medical devices. An Independent Licensee of the Blue Cross and Blue Shield Association. A uniform set of medical policies, including criteria for medical necessity of certain DME/HME products, is established by the Blue Cross and Blue Shield of Nebraska Medical Policy Committee. Behavioral Health Medical Necessity Criteria. bcbstx medical policies and bcbstx clinical payment and coding policies Blue Cross and Blue Shield of Texas (BCBSTX) Medical Policies are based on scientific and medical research. The following codes are included for informational purposes only and are … BCBSRI’s behavioral health vendor, Beacon Health Options, Inc. (Beacon), is changing the medical necessity criteria for behavioral health services effective March 1, 2020. Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association. HMO coverage is offered by Health Options Inc., DBA Florida Blue HMO, an HMO affiliate of Blue Cross and Blue Shield of Florida, Inc. Benefits are determined by the group contract and the subscriber certificate that is in effect at the time services are rendered.These guidelines provide general information regarding the definition of Medical Necessary and Investigational/Experimental services as defined by Blue Cross Blue Shield of North Carolina (BCBSNC). Overview. Our medical guidelines are written to cover a given condition for the majority of people. Therefore, medical policy is not an authorization, certification, explanation of benefits or a contract. In addition, the Program includes Cancer Treatment Pathways (Pathways) based on medical evidence and best practices developed with leading cancer experts. If your patient is unsure about particular coverage/benefits or has questions, please have the member call the Customer Service number on his or her ID card.We comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex.

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