Blue Cross and Blue Shield of Alabama recognizes the key role that practices like yours play in the delivery of quality cancer care. That is why we are pleased to provide our cancer care quality program called Oncology Select. In contract with AIM Specialty Health®, an independent company, Blue Cross offers Oncology Select to help improve patient outcomes, manage costs for cancer care, and provide enhanced reimbursement for Alabama Preferred Medical Doctors (PMDs) who choose Select Pathways.
Following are some important details regarding Blue Cross and Blue Shield of Alabama's Physician-Administered Drug Review Program and precertification requirements:
- All drugs listed on the Physician-Administered Precertification Drug List require precertification; the list can be found under Pharmacy Resources. Please note that the list is updated quarterly. Policies and forms for these drugs are available by selecting the "Physician-Administered Drug Policies and Forms" link below and then choose "Final Physician-Administered Drug Policies and Forms."
- Precertification of oncology chemotherapy drugs and supporting agents, regardless of cancer type, that are listed on the Physician-Administered Precertification Drug List is required through our online solution, the AIM ProviderPortal. It is provided through our partnership with AIM Specialty Health. See “Cancer Treatment Plan Requests and Physician Administered Drug Precertification.” This online precertification process is the same process used for submitting cancer treatment plans.
- To ensure continuity of care, we will add an auto-approved precertification in our system on the provider's behalf for any member who is currently receiving treatment. If a precertification record is added for the member, the member will receive a letter that indicates that his/her drug will continue to be covered for the remainder of their current treatment plan. This will validate that the patient can continue with the current treatment plan as long as no changes/additions are being made to the treatment plan. If a change or addition to a non-certified cancer treatment plan for a patient currently receiving chemotherapy involves a drug listed under Oncology Policies on the Physician-Administered Drug Policies and Forms Web page, you will need to submit a precertification request for that drug(s) and/or addition. If the precertification is not obtained, the service will be denied.
- Non-oncology physician-administered drugs also require precertification. You can precertify these through our online solution, CoverMyMeds. See "How to Initiate a Physician-Administered Drug Precertification."
The majority of Blue Cross and Blue Shield of Alabama members' benefits will require select drugs under the Physician-Administered Drugs Review Program to be precertified. Remember that member eligibility and benefits should be verified at each visit through ProviderAccess or your practice management software.
Regional training sessions were available for physicians, nurse managers who prescribe cancer treatment therapies, practice managers, and preauthorization/billing staff.
AIM Specialty Health is an independent company that partners with leading health plans to promote patient care that is appropriate, safe and affordable.