FEP Standard and Basic Option plans require a prior approval for the procedures listed below. Procedures Requiring Prior Approval for FEP Members. BRCA Testing - Required for both preventative and diagnostic testing. Outpatient surgical services - The surgical services listed below require prior approval when they are to be performed on an outpatient basis. This requirement applies to both the physician and facility services. Brain cancer is not considered a form of head or neck cancer; therefore, prior approval is required for IMRT treatment of brain cancer. Health and dental insurance carrier providing information and online forms for card holders, physicians, dentists, hospitals and group customers.![]() Hospice care - Includes home hospice, continuous home hospice, or inpatient hospice care services. Organ/tissue transplants - See the Service Benefit Plan brochure at www. Prior approval is required for both the procedure and the facility. Prior approval is also required for travel benefits associated with a Blue Distinction Center for Transplants facility approval. Clinical trials for certain organ/tissue transplants - Contact our Transplant Clinical Trials Information Unit at 8. Prescription drugs - Certain prescription drugs under our Retail or Mail Order Pharmacy programs require prior approval. Contact our Retail Pharmacy Program at 8. Note: Updates to the list of drugs and supplies requiring prior approval are made periodically during the year. Include applicable diagnoses, procedure codes, and medical information with your prior approval request form. Prior approvals are usually valid for six months, as long as the patient's benefits do not change between the date the approval is given and the date the service is provided.
You will receive a written response within 1. To request a review of medical necessity and FEP benefits. Pharmacy. Basic Option members must use a Preferred retail pharmacy to obtain prescriptions. Standard Option members can use any Preferred or Non- preferred retail pharmacy. Learn More. The Specialty Pharmacy Program provides personalized pharmacy care and close monitoring to make sure specialty drugs are safe and effective. Learn More. The Discount Drug Program is available to members for specific drugs that are not covered under the regular prescription drug benefit. Learn More. The formulary list is a list of drugs that are considered the preferred treatment for a patient's condition and that can be used as a guide for a doctor when prescribing drugs. Learn More. For certain prescription drugs, the Service Benefit Plan Pharmacy Program must determine whether the drug is related to a service or condition that is covered under the Service Benefit Plan before benefits can be approved. Learn More. Switching your prescriptions to generic drugs can be a great a way to save money. Standard Option members may also be eligible to get the first four prescription fills or refills at no charge when you switch from qualified brand name drugs to generics at a Preferred retail pharmacy or the Mail Service Pharmacy within the same benefit year. ![]() Claim Filing Addresses – Western Region Only Electronic Claim Submission. Federal Employee Program P.O. Box 898854 Camp Hill, PA 17089-8854 ClassicBlue Individual Traditional Indemnity Highmark Major Medical P.O. With Availity’s Eligibility and Benefits Inquiry, users can access printable results that include up to date benefit information. Patient/Subscriber information; Group Number. For Federal Employee Program (FEP) members. A prior approval review determines medical necessity and considers Federal Employee Program (FEP) benefits before a treatment, procedure, service. ![]()
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