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Corporate Medical Policy - Blue Cross NC

Last CAP Review: Next CAP Review: Last Review: ... BCBSA Medical Policy Reference Manual, 8.01.16, 7/12/02 . BCBSA Medical Policy Reference Manual, 10.01.09, 7/12/02 . Page 5 of 11 An Independent Licensee of the Blue Cross and Blue Shield Association Cosmetic and Reconstructive Surgery

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Corporate Medical Policy - Blue Cross NC

www.bluecrossnc.com

Corporate Medical Policy Page 1 of 14 An Independent Licensee of the Blue Cross and Blue Shield Association Genetic Cancer Susceptibility Panels Using Next Generation

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Medicare Part D Excluded Drug List - Blue Cross …

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MEDICARE PART D EXCLUDED DRUGS LIST 2016_updated July 2016 Reason: LIST = multiple reasons it's excluded; "not covered under Part D law". Reason: Not properly listed with FDA = CMS considers it best practice for Part D sponsors to consider the proper listing of a drug product with the FDA as a prerequisite for making a Part D …

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Medicare C/D Medical Coverage Policy Electrical ...

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Neuromuscular Electrical Stimulation (NMES) involves the use of a device that transmits an electrical impulse to the skin over selected muscle groups by way of electrodes. Neuromuscular stimulator devices transmit an electrical impulse to

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PRESCRIBER NAME PRESCRIBER NPI [REQUIRED] …

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last revision february 2017 infliximab (remicade®) prior review/certification faxback form incomplete forms may delay processing all nc providers must provide their 5-digit bcbsnc provider id# below

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Guidelines and Procedures - Blue Cross NC

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The medical policy consists of medical guidelines, including diagnostic imaging management policies, payment guidelines and evidence based guidelines.

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Non-Formulary Exception Request Form - Blue …

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Members HMO: Blue Cross and Blue Shield of North Carolina complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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Formulary(L ist of Covered Drugs) - Blue Cross NC

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i When this drug list (formulary) refers to “we,” “us”, or “our,” it means Blue Cross and Blue Shield of North Carolina. When it refers to “plan” or “our plan,” it means Blue Medicare HMO Essential.

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Prior Authorization Guidelines - Blue Cross NC

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~ Prior Authorization Guidelines ~ Services marked by a bullet in the columns to the left require prior authorization for the designated line of

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Durable Medical Equipment (DME) Providers for Breast Pumps ...

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® Marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association.

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American Dental Association Claim Form - Blue …

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The form is designed so that the name and address (Item 3) of the third-party payer receiving the claim (insurance company/dental The following information highlights certain form completion instructions.

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