Drugs Covered Under the Medical Benefit

When a patient needs a drug under the medical benefit, Blue Cross Blue Shield of Michigan may need to approve it first. Keep in mind that prior authorization is just a clinical review approval, not a guarantee of payment. You'll still need to verify the necessary coverage for this medical benefit.

Registered providers can go to the Physician administered medications page within our Provider Secured Services website for more information on physician-administered medications for patients with Blue Cross coverage, including:

  • Quantity Limit Program information
  • Quantity Limit Request form
  • Frequently Asked Questions about the Prior Authorization of Medical Drugs
  • Forms for the specific medications

Here's how to find the Physician administered medications page:

  1. Log in as a provider at bcbsm.com.
  2. Click BCBSM Provider Publications and Resources on the lower right side of the page.
  3. Click Newsletters and Resources.
  4. Click Go to the Forms page in the right column. (Note: This link appears on most pages of the BCBSM Newsletters and Resources section.)
  5. Click Physician administered medications.

RC Claim Assist tool

RC Claim Assist, created by RJ Health Systems, is a free resource available to Blue Cross Blue Shield of Michigan and Blue Care Network contracted providers who bill for drugs covered under the medical benefit. RC Claim Assist should only be used for claims submitted for Blue Cross or BCN commercial members. The tool provides a comprehensive overview of HCPCS and CPT drug codes, product names and national drug codes. It also offers complete drug information on package-size billable units and reference pricing.

The tool should be used as a general reference only in conjunction with other resources, such as applicable fee schedules. It provides real-time data, reflecting information that's valid as of the day and time you use the tool. The tool doesn't include benefit, payment or medical policy information.

Here are some resources related to RC Claim Assist:

Billing information – for Blue Cross or BCN commercial members only

RC Claim Assist log-in* - tool to help you identify the correct National Drug Code to bill along with the correct NDC billable units and NDC unit of measure

If you have questions about: Do this:
The data you see on RC Claim Assist Send an email to info@rjhealthsystems.com.
Billing or claims Contact Provider Inquiry.
A claim that is contractual or complex in nature Contact your provider consultant.

*Blue Care Network does not control this website or endorse its general content.