Specialty Pharmacy Submission
BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the BlueCross BlueShield Association
BlueCross, BlueShield, BlueCare and the cross and shield symbols are all registered marks of the BlueCross BlueShield Association,
an Association of Independent BlueCross and BlueShield Plans
CPT® is a registered trademark of the American Medical Association
This document has been classified as public information.
Specialty Pharmacy Submission
Enter user ID and password to log on to the secure area of bcbst.com.
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Authorization
Submission
Specialty
Pharmacy
Submission
Select “Commercial/BlueAdvantage/BlueCare®/TennCareSelect”
to begin the authorization submission process.
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Specialty Pharmacy Submission
Special Pharmacy authorizations can be submitted online under
“Authorization/Advance Determination Submission.”
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Specialty Pharmacy Submission
Select “Specialty Pharmacy” to begin the authorization process.
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Specialty Pharmacy Submission
Enter the date of service, then select a member by entering the appropriate
member ID number without the three-letter prefix, then select “Search.”
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Specialty Pharmacy Submission
Highlight correct
member and click.
Member
information will
auto-populate
into the correct
fields.
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Specialty Pharmacy Submission
Select the appropriate Specialty Pharmacy Procedure Code
from the drop-down menu.
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Specialty Pharmacy Submission
Enter the Requesting Provider ID number or search for it.
Servicing Provider ID is not required if it is the same
as the requesting provider.
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Specialty Pharmacy Submission
Search for Providers
by entering ID, name
or location then
clicking “Search.”
A list of possible matches will be
created. Click the correct provider
to auto-populate the authorization
request.
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Specialty Pharmacy Submission
Reminder:
•All fields with an asterisk
must be completed.
•ICD-9 codes should omit
decimals.
•Dates are in MM/DD/YYYY
format.
Specialty Pharmacy
Authorizations cannot
be back-dated.
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Specialty Pharmacy Submission
Select the appropriate options from drop-down menus.
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Specialty Pharmacy Submission
“Apply BlueCross BlueShield of Tennessee Medical Policy Criteria”
is selected by default and is necessary to obtain immediate
online authorization.
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Specialty Pharmacy Submission
If BlueCross BlueShield of Tennessee Medical Policy Criteria are not
applied, supporting information is required here and
the authorization will be pended for review.
When this screen is completed, choose “Continue.”
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Specialty Pharmacy Submission
When the
screen is
completed, a
summary
screen will be
shown.
Please review
the information
for accuracy
and provider
network status.
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Specialty Pharmacy Submission
If changes are needed, click “Back” to go back and correct the information.
When all information is correct, click “Continue.”
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Specialty Pharmacy Submission
Apply BlueCross BlueShield of Tennessee Medical Policy Criteria.
The system will show the guideline associated with the Specialty Pharmacy
code selected. If the guideline is appropriate, click the box next to it and
select “Continue.”
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Specialty Pharmacy Submission
It is also possible to search for a guideline by selecting
“Show All Guidelines” and “Search Guidelines.”
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Specialty Pharmacy Submission
Click “Show All Guidelines” to bring up a
drill-down menu. Click on “+” to drill down
to the appropriate guideline, then select the
specific Specialty Drug.
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Specialty Pharmacy Submission
The “Search
Guidelines” option
will bring up a
search screen and
can be searched by
ICD-9 Code, CPT®
Code or guideline
description.
This example is being searched by description.
Select “Search” after entering code or description.
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Specialty Pharmacy Submission
Select the appropriate guideline and click “Continue.”
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Specialty Pharmacy Submission
Select all that apply, then click “Continue.”
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Specialty Pharmacy Submission
A summary screen will show selected criteria.
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Specialty Pharmacy Submission
If the clinical information submitted meets criteria, an authorization
number will be given. Print this page for your records.
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Specialty Pharmacy Submission
If clinical information does not meet guidelines, submit any additional
clinical information to be considered for review, then click “Finish.”
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Specialty Pharmacy Submission
Authorizations that are pended will generate a confirmation number.
The confirmation number may be used to check status of the request online.
A nurse will call with the decision.
The Gold Card network (Blue Network K) cannot be used for Specialty Pharmacy.
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Questions?
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