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    Step Therapy Program Criteria Summary and Fax Form List ; If you have questions or concerns these programs, please call Prime Therapeutics at Review the prior authorization/step therapy program overview list to help you determine which prior authorization form is used for the medication prescribed. Blue Cross and Blue Shield of Alabama, independent licensee of the. Blue Cross and Blue Shield Association. Prime Therapeutics, an independent. You may fax the signed and completed form to. company, manages pharmacy benefits for Blue Advantage (PPO) members. Clinical Review Dept. at: on behalf of Blue Cross and Blue Shield. Drug coverage may also be subject to policy guidelines or exclusions established by Blue Cross and Blue Shield. The guidelines are meant to help members understand the requirements related to their drug coverage. These drugs may require a doctor’s request for preapproval or prior authorization. How to Obtain Prior Approval. There are three ways to get Prior Approval: Your doctor can submit an electronic prior approval; Your doctor can call us toll-free at between 7 a.m. and 9 p.m. Monday through Friday, Eastern time. This phone number is only for doctor’s offices. Your doctor can submit a paper prior approval. This webpage applies only to Blue Cross and Blue Shield of Alabama individual and family (non-group) plans and underwritten employer group plans. To determine if your employer plan is subject to these additional precertification requirements, your benefit booklet will say “the plan benefits are underwritten” in the Administrative Section at the end of your benefit booklet. Blue Cross Blue Shield of Texas is committed to health care providers with the support and assistance they need. and download these helpful BCBSTX health care provider forms. This link will take you to a new site not affiliated with BCBSTX. The IRS no longer requires us to automatically mail Form B to members. However, you may still request a copy by email (B_Request@ryloa.linkpc.net), by mail (ATTN: Customer Service, Parkway East, AL ) or by the number on the back of your ID card. Prime Therapeutics serves as Blue Cross' Pharmacy Benefit Manager. Together we look for ways to help our members get the medication they need to feel better and live well, while the most cost-effective drug coverage. your web experience you . Nov 16,  · To submit a prior authorization online, please click the button below to use the web form. Online Prior Authorization Form PDF forms are available below to submit a prior authorization .

    For program-specific information, along with helpful worksheets and tutorials, visit the Provider Resource Page on the eviCore website. Or, call our Provider Services at — upon verification of eligibility and benefits, you will be advised how to proceed. Pre-certification also may be required for outpatient services for some employer groups. How to Obtain Benefit Preauthorization There are two ways to submit benefit preauthorization requests to eviCore. Please review the terms of use and privacy policies of the new site you will be visiting. When using pharmacy criteria to determine whether a medication will be covered, please note that member contract language will take precedence over the criteria when there is a conflict. The RQI number is valid for 30 days. Prime Therapeutics LLC is a pharmacy benefit management company. The final decision regarding what medicines should be prescribed, regardless of benefit determination, is a decision between the patient and their physician. Refer to important information for our linking policy. If you have questions or concerns regarding these programs, please call Prime Therapeutics at We review and update the list often. All Rights Reserved. All Rights Reserved. Physicians must complete and submit a request form for all PA and ST medications.

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