Member Policies - Medical Policies - Florida
Policies & Guidelines
- Advanced Imaging
- Behavioral Health
- Chronic Condition Management
- Genetic Testing
- Hemophilia Drugs
- Medical Policies
- Pre-Service Review (Precertification/Predetermination)
- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
- Radiation Therapy
- Self-Administered Drug Policies
- Transgender Services
Provider-Administered Drug Claim Edit Policies
For the provider-administered drugs listed below, claims submitted to the plan must include an appropriate diagnosis code within the drug's policy criteria for claims to process. Any claims submitted with a diagnosis code not found within the policy for that drug, will reject as non-covered.
Precertification criteria does not apply for these policies.
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