My.capbluecross.com

Capital Blue Cross

WebHealthcare benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company ®, Capital Advantage Assurance Company ® and Keystone Health Plan ® Central. Independent licensees of the Blue Cross Blue Shield Association serving 21 counties in Central Pennsylvania and the Lehigh Valley.

Actived: 8 days ago

URL: https://my.capbluecross.com/

Drug Infusion Site of Service

WebMEDICAL POLICY POLICY TITLE DRUG INFUSION SITE OF SERVICE POLICY NUMBER MP 3.016 1 Effective 1/1/2024 Effective Date: 1/1/2024 I. POLICY Note: An injectable medication must meet applicable medical necessity criteria for coverage. When coverage criteria are met for the injectable medication, this policy is used to determine

Category:  Medical Go Health

Pharmacy Benefit Claim Form

WebUse a separate claim form for each member and prescription. Complete Section 1 and Section 2 on the front of this form and Section 4 below if applicable. All information provided on or attached to this claim form must be for the same person/prescription. 2. Attach original itemized pharmacy receipts provided with your prescription.

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DEN-50: Enhanced Dental Benefits Self-Reporting Form

Web*Coverage for enhanced dental benefits is an optional benefit that may not be included in your plan. Consult your Benefits Booklet for benefits details.

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Capital Blue Cross Value Formulary Update

Web2nd & 3rd Quarter 2023 (effective January 1, 2024) The Capital BlueCross formulary is a reference list of prescription drugs that contains a wide range of generic and brand drugs that have been approved by the U.S. Food and Drug Administration (FDA). The formulary is updated on a quarterly basis or when new generic or brand-name …

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Out-of-Network Facility Reimbursement QRG

WebOut-of-Network Facility Reimbursement Quick Reference Guide Healthcare benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company®, and Keystone Health Plan® Central. Independent licensees of the Blue Cross Blue Shield Association …

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NF-778: Preauthorization Letter of Medical Necessity

WebTitle: NF-778: Preauthorization Letter of Medical Necessity Author: Capital BlueCross Subject: NF-778_interactive.pdf Created Date: 3/26/2020 2:02:02 PM

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Proactive and personalized healthcare for your employees

WebJoe can stay focused on his health with guidance and support from his doctor who: • Reminds him to schedule preventive medical tests • Coordinates follow-up care

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P TITLE Services In Addition To A Basic Service

WebPROFESSIONAL NETWORK REIMBURSEMENT POLICY POLICY TITLE Services In Addition To A Basic Service POLICY NUMBER NR-09.902 Page 1 of 5 Health care benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company® and …

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HEDIS follow-up after emergency department visit for alcohol …

WebOverview •HEDIS FUA assesses the percentage of visits to any outpatient provider after an emergency department (ED) visit. •FUA is measured at 7 and 30 days (ED visit does not count as a day),

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BH-140: Substance Use Disorder Presentation

WebWhat is substance use disorder? •Substance use disorder: a medical condition that is defined by the inability to control the use of a particular substance (or substances) despite harmful consequences. •Substances can be prescribed medications being improperly used or illicit narcotics/drugs obtained illegally for consumption.

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Making Health Care Easier

WebThe amount you have to pay for services covered by insurance before your insurance begins to pay. For example, if your deductible is $1,000, you pay the

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MRxM Danyelza 01 23

WebPage 2 | DANYELZA® (naxitamab-gqgk) Prior Auth Criteria Proprietary Information. Restricted Access – Do not disseminate or copy without approval.

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Improving member health outcomes through effective …

WebAgenda 1 1 The role of providers in relation to behavioral health. 2 A strong foundation for care and coordination. 3 Communication responsibilities to other providers. Improving care and coordination between medical and behavioral health. 4 5 Final thoughts and resources.

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Provider Toolkit Tip Sheet

WebProvider Toolkit Tip Sheet FUH is a Healthcare Effecfiveness Data and Informafion Set (HEDIS®) measure. See the Nafional Commiftee for Quality Assurance (NCQA) website for more details.

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P TITLE General Coding Guidelines

WebPROFESSIONAL NETWORK REIMBURSEMENT POLICY POLICY TITLE General Coding Guidelines POLICY NUMBER NR- 30.001 Page 1 of 6 Health care benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company® and Keystone Health Plan® …

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ROFESSIONAL ETWORK EIMBURSEMENT POLICY

WebPROFESSIONAL NETWORK REIMBURSEMENT POLICY POLICY TITLE Correct Coding and Reimbursement Methodology POLICY NUMBER NR- 30.019 Page 1 of 5 Health care benefit programs issued or administered by Capital Blue Cross and/or its subsidiaries, Capital Advantage Insurance Company®, Capital Advantage Assurance Company® and …

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Capital +, Provider Toolkit Tip Sheet

WebProvider Toolkit Tip Sheet . FUH is a Healthcare Effeciveness Data and Informaion Set (HEDIS®) measure. See the Naional . Commitee for Quality Assurance (NCQA) website for more details.

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