BCN providers use the NovoLogix electronic system to submit specialty medical drug authorization requests for members covered under BCN HMOSM (commercial) and BCN AdvantageSM plans. BCN no longer accepts these requests through the e-referral system.
The resource documents on this page will guide you in submitting these requests to NovoLogix.
NovoLogix is an independent company with a web-based tool used to request prior authorization for specialty medical medications.
- Novologix training video on requesting authorizations:
- Click here*.
- Click the arrow located in the center of the "Provider Authorization Video Tutorial" box, to start the video.
Authorization and medical necessity criteria resources
- Frequently asked question for BCN providers (PDF)
- Medical Benefit Drug Request Form (PDF)
- For BCN HMO (commercial) members:
- Requirements for drugs covered under the medical benefit – BCN HMO (PDF)
- Newsletter articles about BCN commercial members (PDF)
- For BCN Advantage members:
Billing/pricing information - for 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
- RC Claim Assist webinar presentation (PDF)
- Frequently asked questions about RC Claim Assist (PDF)
- Newsletter articles about pricing (PDF)
- Specialty Drug Visit Summary form (PDF)
- Billing instructions: Reporting the National Drug Code (PDF)
If you need assistance, you can contact the Pharmacy Help Desk:
- By phone: 1-800-437-3803
- By fax:
- For BCN HMO (commercial) members, fax to 1-877-325-5979.
- For BCN Advantage members, fax to 1-866-392-6465.
You can refer to the Pharmacy chapter of the BCN Provider Manual for additional information about drugs covered under the medical benefit. Here's how to access the information in the Pharmacy chapter:
- Visit bcbsm.com/providers and click Login.
- Log in as a provider, using your user name and password.
- Click BCN Provider Publications and Resources.
- Click Provider Manual.
- Click Pharmacy.
- Look in the section titled "Drugs covered under the medical benefit."
Here are some of the topics you can read about in the Pharmacy chapter:
- Examples of drugs covered under the medical benefit
- Requesting authorization for drugs administered in specialty clinics or practitioners' offices
- Purchasing drugs for administration in specialty clinics or practitioners' offices
- NDC pricing and billing for drugs administered in practitioners' offices and in home settings
- Billing for medications administered at outpatient infusion centers
- Maximum payable amounts