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November 2020

Starting Dec. 1, some drugs covered under medical benefit will require authorization for Blue Cross and Blue Shield FEP non-Medicare members

For dates of service on or after Dec. 1, 2020, providers will have to request authorization from Blue Cross Blue Shield of Michigan for some drugs covered under the medical benefit for Blue Cross and Blue Shield Federal Employee Program® non-Medicare members. Authorization will be required only when members receive the drugs in Michigan.

The drugs that will require authorization are listed in the Utilization management medical drug list for Blue Cross and Blue Shield Federal Employee Program non-Medicare members document.

Note: For dates of service prior to Dec. 1, 2020, authorization isn’t required for drugs covered under the medical benefit for Blue Cross and Blue Shield FEP non-Medicare members.

What you need to do

  • Request authorization from Blue Cross for members affected by this change.
  • Verify that members have active coverage on the date of service and that medications and services are covered under the Blue Cross and Blue Shield FEP.

Resources

The Blue Cross and Blue Shield FEP has its own policies for drugs that require authorization. The policies are available on the Medical Policies page of the Blue Cross and Blue Shield Federal Employee Program website.

In mid-October, we’ll make available the list of medical benefit drugs that require authorization for Blue Cross and Blue Shield FEP non-Medicare members. Look for the list on the Blue Cross Medical Benefit Drugs page of the ereferrals.bcbsm.com website.

We’ll have additional information in web-DENIS messages and in future issues of The Record.

How to submit authorization requests

You can submit authorization requests using one of the following methods:

  • By fax. Starting Nov. 1, you can submit authorization requests by fax. For information about the forms you’ll use to submit authorization requests, contact the Pharmacy Clinical Help Desk at 1-800-437-3803.
  • Online through the NovoLogix® online tool. Starting Dec. 1, 2020, you can submit authorization requests through NovoLogix. The tool offers real-time status checks and immediate approvals for certain medications.

    To learn how to submit requests through NovoLogix, go to ereferrals.bcbsm.com, click on Blue Cross and then on Medical Benefit Drugs. In the Blue Cross PPO (commercial) column, go to the How to submit authorization requests electronically using NovoLogix section.

Additional information

Authorization isn’t a guarantee of payment. Health care practitioners need to verify eligibility and benefits for members.

The list of drugs in the Utilization management medical drug list for Blue Cross and Blue Shield Federal Employee Program non-Medicare members document applies only to Blue Cross and Blue Shield FEP non-Medicare members.

For requirements related to drugs covered under the medical benefit for other Blue Cross commercial members and for BCN commercial members, see the following pages of the ereferrals.bcbsm.com website:

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 2019 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.