Please note, this communication applies to Healthy Blue + Medicare^℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

Effective November 1, 2023, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Blue Cross NC for Medicare members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

Not all PA requirements are listed here. Detailed PA requirements are available to providers at Experience Health Providers | Blue Cross NC and scroll down to Drug Information for Medicare Members and select Prior Approval and Quantity Limits or for contracted providers by accessing Availity.com.

Note: Availity, LLC is an independent company providing administrative services for Healthy Blue + Medicare providers on behalf of Blue Cross and Blue Shield of North Carolina

NCBCBS-CR-028193-23-CPN27641 July 2023  UM AROW 4505