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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.
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.
Precertification criteria does not apply for these policies.