PA Resources Portlet

Resources

CODING & DOCUMENTATION

EDUCATION & EVENTS

ENROLLMENT & CREDENTIALING

FORMS & MANUALS

HEALTHCARE INFORMATION & TECHNOLOGY

PATIENT HEALTH

PHARMACY

POLICIES & GUIDELINES

Advanced Imaging

Autism Spectrum Mandate

Behavioral Health

Blue AdvantageĀ® Policies

Chronic Condition Management

Clinical Practice Guidelines

HelpScript

Hemophilia Drug Management

Medical Nutrition Therapy Services

Medical Policies

Medical Records Requests

No Surprise Billing Act

Operational Guidelines

Provider Appeals

Provider Disputes

Provider-Administered Drug Policies

Radiation Therapy Management (RTM)

Self-Administered Drug Policies

Subrogation

Telehealth and Remote Access Telemedicine

Transgender Services

PRE-SERVICE REVIEW

PROGRAMS & INITIATIVES

PROVIDER NETWORKS & SPECIALTIES

PA Dynamic Rendering

Provider-Administered Drug Review Program

Blue Cross and Blue Shield of Alabama requires precertification of provider-administered drugs managed under a medical policy. Currently, precertification for these provider-administered drugs is required when administered in a provider's office, outpatient facility or home health setting. If precertification is not obtained, coverage will not be provided under the plan for the provider-administered drug. The Provider-Administered Precertification Drug List contains the list of drugs subject to the Provider-Administered Drug Review Program.

Precertification for oncology and non-oncology drugs can be initiated by following a link that appears in ProviderAccess Eligibility and Benefits for eligible members. Precertification review for provider-administered drugs is performed by Prime Therapeutics. 

Find answers to questions about the Drug Wastage Program’s expansion through Prime Therapeutics.

Online policies can be found at AlabamaBlue.com/Providers/Policies.

If you have questions, contact your Provider Engagement Consultant at 1-866-904-4130.