Provider-Administered Drug Claim Edit Policies

For the provider-administered drugs linked below, claims submitted to the plan must include an appropriate diagnosis code within the drug’s policy criteria along with units and frequencies in alignment with the dosing limits. Any claims submitted with a diagnosis code not found within the policy for that drug or units and frequencies in excess of the dosing limits will reject as non-covered.

Click the link below to locate specific policy information.
Provider-Administered Drug Claim Edit Policies

Precertification criteria does not apply for these policies.

Note: Coverage is subject to the member's specific benefits. Group-specific benefits will supersede these policies when applicable. Always check eligibility and benefits through your local Blue Plan provider portal or your practice management system to confirm member-specific benefits.