Specialty Pharmacy Submission

Specialty Pharmacy Submission

BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield AssociationBlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association,

an Association of Independent BlueCross and BlueShield PlansCPT® is a registered trademark of the American Medical Association

This document has been classified as public information.

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Enter user ID and password to log on to the secure area of bcbst.com.

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Authorization SubmissionSpecialty Pharmacy Submission

Select “Commercial/BlueAdvantage/BlueCare®/TennCareSelect” to begin the authorization submission process.

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Authorization SubmissionSpecialty Pharmacy Submission

Select “Commercial/BlueAdvantage/BlueCare®/TennCareSelect” to begin the authorization submission process.

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Special Pharmacy authorizations can be submitted online under “Authorization/Advance Determination Submission.”

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Select “Specialty Pharmacy” to begin the authorization process.

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Enter the date of service, then select a member by entering the appropriate member ID number without the three-letter prefix, then select “Search.”

Specialty Pharmacy Authorizations cannot be back-dated.

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Highlight correct member and click.

Member information will auto-populate

into the correct fields.

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Select the appropriate Specialty Pharmacy Procedure Codefrom the drop-down menu.

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Enter the Requesting Provider ID number or search for it.

Servicing Provider ID is not required if it is the sameas the requesting provider.

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Search for Providers by entering ID, name or location then clicking “Search.”

A list of possible matches will becreated. Click the correct providerto auto-populate the authorization request.

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Reminder:

•All fields with an asterisk must be completed. •ICD-9 codes should omit decimals.•Dates are in MM/DD/YYYY format.

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Select the appropriate options from drop-down menus.

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“Apply BlueCross BlueShield of Tennessee Medical Policy Criteria” is selected by default and is necessary to obtain immediate

online authorization.

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If BlueCross BlueShield of Tennessee Medical Policy Criteria are not applied, supporting information is required here and

the authorization will be pended for review.When this screen is completed, choose “Continue.”

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When the screen is

completed, a summary

screen will be shown.

Please review the information

for accuracy and provider

network status.

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If changes are needed, click “Back” to go back and correct the information. When all information is correct, click “Continue.”

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Apply BlueCross BlueShield of Tennessee Medical Policy Criteria.

The system will show the guideline associated with the Specialty Pharmacy code selected. If the guideline is appropriate, click the box next to it and

select “Continue.”

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It is also possible to search for a guideline by selecting “Show All Guidelines” and “Search Guidelines.”

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Click “Show All Guidelines” to bring up a drill-down menu. Click on “+” to drill down to the appropriate guideline, then select the specific Specialty Drug.

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The “Search Guidelines” option will bring up a search screen and can be searched by ICD-9 Code, CPT® Code or guideline description.

This example is being searched by description.Select “Search” after entering code or description.

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Select the appropriate guideline and click “Continue.”

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Select all that apply, then click “Continue.”

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A summary screen will show selected criteria.

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If the clinical information submitted meets criteria, an authorizationnumber will be given. Print this page for your records.

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If clinical information does not meet guidelines, submit any additional clinical information to be considered for review, then click “Finish.”

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Authorizations that are pended will generate a confirmation number. The confirmation number may be used to check status of the request online.

A nurse will call with the decision.

The Gold Card network (Blue Network K) cannot be used for Specialty Pharmacy.

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Questions?

Specialty Pharmacy Submission

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