Reminder: Starting Oct. 1, additional specialty medications require authorization for BCN AdvantageSM members

For dates of service on or after Oct. 1, 2018, additional specialty medications covered under the Medicare Part B medical benefit require authorization for BCN Advantage members.

We first communicated about this in the article Starting Oct. 1, additional specialty medications require authorization for BCN Advantage members, on page 28 of the July-August 2018 BCN Provider News. Please review the article to see which drugs require authorization starting October 1.

These medications are not self administered. They must be given by injection or infusion by a physician or health care professional in the office or outpatient facility setting.

These medications require authorization when billed as a professional service (via the paper HCFA 1500 claim form or electronically as an 837P transaction) or as an outpatient facility service (via the UB-04 or electronically as an 837I transaction) and one of the following place of service codes is used:

We also published an update in the article Clarification: Vivaglobin does not require authorization, on page 8 of the September-October 2018 BCN Provider News.

In addition, an updated list of drugs requiring authorization for BCN Advantage members will be available on this website by the end of September. To see the list, click BCN and then click Medical Benefit Drugs – Pharmacy. Finally, click Requirements for drugs covered under the medical benefit – BCN Advantage.

Note: This communication updates earlier ones, including the newsletter articles, which incorrectly stated that authorization is not required for these medications when they are billed on a facility claim form (such as the UB 04) or electronically via an 837I transaction. We apologize for this error.

Posted: September 2018
Line of business: Blue Care Network