(CT Scans, MRIs/MRAs, PET Scans, Nuclear Medicine)
|Authorization, certification, or notification not required; however, VPCR is available.|
||Prior approval required if participating in the PADP. Refer to Magellan Rx Management at www.ihmagellanrx.com. |
||No authorization, certification or notification required.|
||No authorization, certification or notification required. |
Prior authorization is required and is managed by our specialty pharmacy, Express Scripts
(Acute, Psych, Substance and LTAC)
Preadmission certification required for acute care, LTAC and psychiatric and substance hospitals.
- Penalty is 20 percent of the allowed amount, not to exceed $500.
- Exceptions are:
- When Medicare A is primary
- VA hospitals
- Out of country hospitals
Quest Diagnostics is BCBSF's preferred provider. Services obtained at other facilities will incur higher out-of-pocket cost for the member.
||Authorization, certification, or notification is not required.|
VPCR is available.
(excluding office visit)
|Prior benefit determination must be obtained for all transplants, except for kidney or cornea. Contact BCBSF to determine if benefit applies.|