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April 2015

Training tips and opportunities: Resources to help make your job easier

This is part of a series designed to make you aware of the resources available to health care providers and how to access them. This month we’ll take a look at the Blue Cross Blue Shield of Michigan prior authorization forms for drugs paid under the pharmacy benefit and those paid under the medical benefit for our commercial members.

Pharmacy drug benefit

Two types of drug prior authorization requests

This section outlines the online process available for prior authorizations of self-administered drugs covered under the Blues pharmacy drug benefit. The process differs from the prior authorizations described in "Medical benefit: physician-administered medications" section below. The prior authorizations for these drugs are processed differently because they are covered under the Blues medical benefit.

Note: This information does not apply to our Medicare members. For these members, you would use the Medicare Part D form available on web-DENIS.

  • From the homepage of web-DENIS, click on BCBSM Provider Publications and Resources.
  • Click on Newsletters & Resources.
  • Under "Frequently Used Forms," click on Pharmacy Prior Authorization/Step Therapy Forms.
  • Click on Medicare Part D form.

As part of our efforts to make the drug prior authorization process more efficient, we’re asking prescribers to use our Web-based system when prescribing drugs for commercial members. You can identify commercial members by one of the following Rx group codes on their ID cards: BCBSMAN or BCBSMRX1.

Follow these easy steps:

1. Log in to web-DENIS through the Provider section of bcbsm.com.
2. Click on Medication Prior Authorization.
3. Enter the drug requested in the Drug Search Form.
4. Click on the drug name.
5. Enter patient and physician information.
6. Answer a few questions related to the drug selected.
7. Click on Submit. (Once submitted, you will receive a tracking number for future reference).

Your request will be placed in the queue for review by a member of the clinical staff. You can go online and check the status of a request at any time.

Offices that don’t support online options can fax prior authorization requests to 1-866-601-4425 or call 1-800-437-3803.

Lists showing drugs included in our pharmacy programs can be found on our Web-based prior authorization system or at bcbsm.com/rxinfo.

Note: At this time, the online prior authorization system cannot be used when prescribing drugs for Federal Employee Program® members. Call 1-800-624-5060 for information on how to handle drug prior authorization for FEP members.

Medical benefit: physician-administered medications

The physician-administered medication link on web-DENIS lists forms to request prior authorization for drugs administered by a health care professional and billed under a member’s medical benefit. By using this link, you can also find the list of groups that are not included in the BCBSM Medical Drug Prior Authorization Program.
To access the link, log in to web-DENIS.

  • Click on BCBSM Provider Publications and Resources.
  • Click on BCBSM Newsletters and Resources.
  • Under “Frequently used forms,” click on Physician administered medications.

As with the pharmacy drug benefit, we encourage prescribers to register and use our Web-based system when prescribing drugs that are billed under the medical benefit for commercial members. This new application gives you the ability to submit forms electronically and look up the status of medical drug prior authorization requests. For more information, contact your provider consultant.

In order to be able to submit your prior authorization requests electronically, you will need to:

  • Become a registered web-DENIS user.
  • Complete the addendum P form in the Medical Drug Prior Authorization area of bcbsm.com/providers. Here’s how to get there:
    • From the homepage of bcbsm.com/providers, scroll down and click on Provider Secured Services.
    • Scroll down and click on the link that says: Medical drug prior authorization: physicians can make an online request for prior authorization of specialty drugs.
No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.