Specialty Pharmacy Submission
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield AssociationBlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association,
an Association of Independent BlueCross and BlueShield PlansCPT® is a registered trademark of the American Medical Association
This document has been classified as public information.
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Specialty Pharmacy Submission
Enter user ID and password to log on to the secure area of bcbst.com.
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Authorization SubmissionSpecialty Pharmacy Submission
Select “Commercial/BlueAdvantage/BlueCare®/TennCareSelect” to begin the authorization submission process.
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Authorization SubmissionSpecialty Pharmacy Submission
Select “Commercial/BlueAdvantage/BlueCare®/TennCareSelect” to begin the authorization submission process.
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Specialty Pharmacy Submission
Special Pharmacy authorizations can be submitted online under “Authorization/Advance Determination Submission.”
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Specialty Pharmacy Submission
Select “Specialty Pharmacy” to begin the authorization process.
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Specialty Pharmacy Submission
Enter the date of service, then select a member by entering the appropriate member ID number without the three-letter prefix, then select “Search.”
Specialty Pharmacy Authorizations cannot be back-dated.
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Specialty Pharmacy Submission
Highlight correct member and click.
Member information will auto-populate
into the correct fields.
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Specialty Pharmacy Submission
Select the appropriate Specialty Pharmacy Procedure Codefrom the drop-down menu.
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Specialty Pharmacy Submission
Enter the Requesting Provider ID number or search for it.
Servicing Provider ID is not required if it is the sameas the requesting provider.
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Specialty Pharmacy Submission
Search for Providers by entering ID, name or location then clicking “Search.”
A list of possible matches will becreated. Click the correct providerto auto-populate the authorization request.
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Specialty Pharmacy Submission
Reminder:
•All fields with an asterisk must be completed. •ICD-9 codes should omit decimals.•Dates are in MM/DD/YYYY format.
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Specialty Pharmacy Submission
Select the appropriate options from drop-down menus.
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Specialty Pharmacy Submission
“Apply BlueCross BlueShield of Tennessee Medical Policy Criteria” is selected by default and is necessary to obtain immediate
online authorization.
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Specialty Pharmacy Submission
If BlueCross BlueShield of Tennessee Medical Policy Criteria are not applied, supporting information is required here and
the authorization will be pended for review.When this screen is completed, choose “Continue.”
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Specialty Pharmacy Submission
When the screen is
completed, a summary
screen will be shown.
Please review the information
for accuracy and provider
network status.
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Specialty Pharmacy Submission
If changes are needed, click “Back” to go back and correct the information. When all information is correct, click “Continue.”
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Specialty Pharmacy Submission
Apply BlueCross BlueShield of Tennessee Medical Policy Criteria.
The system will show the guideline associated with the Specialty Pharmacy code selected. If the guideline is appropriate, click the box next to it and
select “Continue.”
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Specialty Pharmacy Submission
It is also possible to search for a guideline by selecting “Show All Guidelines” and “Search Guidelines.”
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Specialty Pharmacy Submission
Click “Show All Guidelines” to bring up a drill-down menu. Click on “+” to drill down to the appropriate guideline, then select the specific Specialty Drug.
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Specialty Pharmacy Submission
The “Search Guidelines” option will bring up a search screen and can be searched by ICD-9 Code, CPT® Code or guideline description.
This example is being searched by description.Select “Search” after entering code or description.
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Specialty Pharmacy Submission
Select the appropriate guideline and click “Continue.”
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Specialty Pharmacy Submission
Select all that apply, then click “Continue.”
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Specialty Pharmacy Submission
A summary screen will show selected criteria.
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Specialty Pharmacy Submission
If the clinical information submitted meets criteria, an authorizationnumber will be given. Print this page for your records.
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Specialty Pharmacy Submission
If clinical information does not meet guidelines, submit any additional clinical information to be considered for review, then click “Finish.”
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Specialty Pharmacy Submission
Authorizations that are pended will generate a confirmation number. The confirmation number may be used to check status of the request online.
A nurse will call with the decision.
The Gold Card network (Blue Network K) cannot be used for Specialty Pharmacy.
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Questions?