In The Know Series – Page 4 – KR2 Medical Billing

In The Know Series, Insurance, My services

Anthem BCBS members: Screening for Vitamin D Deficiency in Average Risk Individuals

Posted on October 8, 2019December 13, 2019 by KR2Medical Billing

Previously, I published an article regarding Aetna Vitamin D Testing (click here to view it)

The following is the policy for Anthem BCBS:

Things to consider:

Original date for this policy is 09/13/2017
Policy was updated and reviewed on 08/22/2019
Publish date: 09/25/2019
The updated sections: discussion and general information
Note the coding section provided
Note the recommendation section in the policy

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In The Know Series, Insurance, Training

UHC Commercial and Oxford updated policy for Eucrisa® (crisaborole)

Posted on September 25, 2019December 13, 2019 by KR2Medical Billing

Eucrisa® (crisaborole) coverage has gone through changes in the past 2 years.

In this episode we will cover only the coverage for UHC Commercial + Oxford policies

Things to take in consideration:

Eucrisa® (crisaborole) is part of Pharmacy Benefit for UHC Commercial + Oxford policies.
It is a Step Therapy
Policy was created in 07/2017 and Updated with no changes on 07/2018
Effective Date is 10/01/2018
Authorization is given for 12 months
If the patient had samples of Eucrisa prior to the provider initiating Prior approval, that patient still needs to meet the Step Therapy requirement

Please look below for reference:

uhceucrisa1

uhceucrisa1 Capture

In The Know Series, Insurance, My services, Training

OptumRx and prior authorization fax numbers-updated 2019

Posted on August 10, 2019August 10, 2019 by KR2Medical Billing

As of 11/01/2019 OptumRx will be “retiring” the following fax numbers, for the plans that it manages the pharmacy benefits:

800-527-0531

855-806-3524

855-806-3525

855-806-3526

800-203-1664

800-382-8135

From 11/01/2019 on wards providers would need to visit an online website to complete the prior authorization:

https://professionals.optumrx.com and click on the Prior Authorization link.

Due to individual state guide lines, the providers in the following states are to still use the fax to request the Prior Authorization:

Massachusetts

Rhode Island

South Carolina

Texas

The new fax number, for the providers located in the above states, will be available via online starting in October of 2019