If you are administering medication to a member in your office or in an outpatient setting, we encourage you to take these steps:
|Step||Check member benefits and eligibility. Use a self-service technology like Online Services or contact us.
Members do not have medical benefits for these medications:
Determine whether authorization for the medication is required.
To do this, view our medical policies for the medication:
Medical Utilization Management (MED UM) & Pharmacy Prior Authorization Policy (033)
Medical Utilization Management (MED UM) Drug List (034)
Learn how to request prior authorization.
Federal Employee Program members
Fax in your written request, along with relevant medical record documentation, to 1-888-282-1315. You must write "Advanced Benefit Determination" on the front of your cover page.
Medicare Advantage members
|Step||Perform the service and submit your claim.|