#covermymeds – KR2 Medical Billing

The Process will be in 2 phases.

Phase 1 will begin on 04/28/21- on or after this date BCBS NC will transition to Cover My Meds and the pharmacy call center team, from Care Radius.

Partial Lis of Phase 1 medications:

During Phase 1 providers should still use existing process (i.e., Care Radius or 800-571-7942), to request prior authorizations for medications that are NOT on the PHASE 1 list.

Phase 2- will begin on or after 06/16/2021 and providers will need to contact Cover My Meds or pharmacy call center team, to request an authorization.

Below is partial list for Phase 2 medications:

How to request an authorization:

Please note: Phase 1 medical drug Corporate Medical Policies and associated fax forms will be moving to www.bluecrossnc.com/umdrug. We will notify you when this shift occurs via another news article. Once this move occurs, you may notice some formatting/layout changes to policies. If there is a policy change, this will be communicated separately.

To see the whole list of Phase 1 and Phase 2 medications please click here.

#priorauthorizations, #medications, #covermymeds

Just a reminder to all of providers that accept EmblemHealth Commercial and Exchange Plans- starting 08/03/2020 Express Scripts will be responsible for utilization management of most specialty and step therapy drugs (specialty medications).

This change does NOT apply to EmblemHealth Medicaid and Medicare Plans or adult chemotherapy and supportive agents. Providers should follow the prior authorization guidelines through EmblemHealth. (Please see below)

EmblemHealth Commercial and Exchange Plans– Requesting an EPA (electronic Prior Authorization) Steps:

1. If your practice utilizes an EHR, you would be able to order it electronically.

2. You may also utilize: Covermymeds, Surescipts or ExpressPath- here you are able to create a free account and request an ePA.

Request Prior Auth by Phone & Fax:

1. Pharmacy Drug Reviews- phone 844-516-3324 (available 24/7/365) or by fax#: 877-251-5896

2. Medical Drug Reviews- phone 877-681-9866 (available 8am to 7pm EST) Monday through Friday, or by fax#: 866-896-1209

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Requesting Prior Authorizations for EmblemHealth Medicaid and Medicare Plans:

1. Specialty Drugs- phone 888-447-0295 (available 8am to 6pm, Monday through Friday), or fax# 877-243-4812

2. Pharmacy Drugs- phone 877-362-5670 (available 8am to 6pm, Monday through Friday) or fax# 877-300-9695

IMPORTANT: if your patient has received an Authorization Approval prior to 08/03/2020, from EmblemHealth- it is valid until the expiration date of the authorization. Subsequent requests have to go through Express Scripts NOT EmblemHealth. (Your claims will be denied if you do not request an authorization from Express Scripts after 08/03/2020 and beyond)

For the full provider announcement, please see the slideshow below.

Tag: #covermymeds

BCBS North Carolina-change to Medications Prior Authorization process 04/28/21 & 06/16/21

EmblemHealth Commercial and Exchange Plans – order Prior Auths through Express Scripts

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