Transcription of Total Healthcare Management, Utilization …
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Total Healthcare Management, Utilization …
Total Healthcare management , Utilization management and Transition of Care 58 59 Commercial Authorization Submission Options and Requirements Options: Online -- Register via BlueAccessSM at -- 24/7 access -- Automated approvals when guidelines met Phone 1-800-924-7141 (423) 535-5717, option 2 Fax See Transition of Care contact list Commercial Requirements 60 Medical Policy Criteria Hierarchy Commercial BlueCare MedAdvantage of Coverage (EOC) / Benefit Plan Medical Policy Guidelines (Not used for pharmaceutical/specialty medication agents) applicable, a Vendor Program Policy ( , MedSolutions) is used by the vendor in the absence of a BlueCross or MCG document addressing a given topic. _____ Durable Medical Equipment: Medical Policy Guidelines (Durable Medical Equipment Medicare Administrative Contractor) Note: All requests/claims for oral pharmaceutical / specialty medication agents are adjudicated using the PBM s policies.
• Reconsideration (when services are still active) – Provide additional information via web/phone/fax. • Peer-to-Peer (two dates and times required)
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