Blue cross blue shield alabama prior authorization form

Wellmark uses Availity for electronic data interchanges (EDI) transactions including:

• Electronic claim submissions (837)
• Electronic remittance advices (ERA) (835)
• Requests and responses for eligibility and benefits (270/271)

Log in to Availity External Link

Don't have an Availity account? Register here External Link.

All network participation forms can be found on the Provider Credentialing page. Or, visit the credentialing Submission Tracker to track the status of your applications, recredentialing submissions and change requests.

Pharmacy exception requests for non-formulary medications

• If your patient needs a non-formulary drug, he or she may ask for an exception request. This process may allow coverage for those drugs not included in his or her drug list. To review this process, please visit the CVS Caremark® Prior Authorization External Link page. Your patient also has the option of contacting Wellmark Customer Service at the number printed on the back of his or her ID card.

Drug authorization process

• Please start by referencing the drug authorization list. Use the drug authorization table to see a list of Wellmark's drug policies. If a drug is not listed, Wellmark does not maintain a policy for it.
• Prescribing providers may also use the CVS Caremark Global Prior Authorization form External Link page.

Specialty pharmacy programs

• To enroll your patients in specialty pharmacy programs:
• CVS Caremark - Enroll online External Link or call 800-237-2767
• Hy-Vee - Enroll online External Link or call 877-794-9833

Request for waiver of brand penalty

• Depending on your patient’s benefits, if a brand drug is filled when a generic alternative is available, your patient will pay their copay or coinsurance plus the cost differential between the generic and brand drug. You may submit a request for your patient to receive the brand-name drug when a generic alternative is available and only pay the applicable cost-share by using the Request for waiver of brand penalty form PDF File.

Preventive services contraceptive zero copay exception

• In accordance with Patient Protection and Affordable Care Act requirements, providers may request a zero-dollar coverage exception review for contraceptives when the requested drug is medically necessary to prevent pregnancy. Submit by fax using the preventive services contraceptive zero copay exception form PDF File, through CoverMyMeds, or call 800-600-8065 to request an exception.

Log in to view Appeals and Inquiries Secure Site information.

Note: The post-service provider appeal process does not apply to overpayment recovery requests. If you have received an overpayment recovery request and do not agree with our reasons for requesting the refund, submit an overpayment recovery appeal.

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GENERAL PRESCRIPTION DRUG COVERAGE AUTHORIZATION REQUEST From An Independent Licensee of the Blue Cross and Blue Shield AssociationGENERAL INFORMATION Request Type (please check one)This form is for

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Music Blue Cross and Bluesier of Alabama has provided healthcare coverage to Alabama and has been a trusted leader in the healthcare industry for 81 years why it's about consistently doing the right things for the right reasons for their customers created in 1936 to serve Alabama's Blue Cross now has over 3 million members including over 21 million members in Alabama with another nine hundred twenty thousand out-of-state Blue Cross and Blue Shield of Alabama is proud of the fact that Alabama has the lowest average family premiums among employers in the nation Blue Cross's mission remains to provide employers families and individuals access to quality affordable health care validating that commitment is the almost 20000 employer groups nationwide selecting Blue Cross as their health insurance carrier Blue Cross offers a wide variety of health and dental plans in all 67 Alabama counties giving individuals families and employers choices that best meet their needs Blue Cross also provides the broadest network of doctors hospitals and pharmacies in Alabama giving members freedom of choice and ensuring quality care is easily accessible as one of the most efficient health insurers in the industry Blue Cross provides the best value for their members health care dollars approximately 92 cents is returned to customers and health care benefits 7 cents goes toward operating expense and less than a penny for net income these numbers are why Blue Cross has been an industry leader with one of the lowest operating costs in the nation Blue Cross is at the forefront and claims efficient by processing over 75 million claims per year with a 99 accuracy rate they understand their customers needs, so each claim is handled with the utmost importance and urgency and most claims are processed within 7 days Blue Cross and Blue Shield of Alabama has also been recognized by JD Power for ranking highest in member satisfaction among commercial health plans in the East South Central Region Blue Cross is also dedicated to helping Alabamians lead healthy lifestyles which leads to lower health care costs in the last year Blue Cross and its foundation the caring Foundation have donated over six million dollars statewide to over 500 charitable organizations in support of health and education initiatives doing the right things for the right reasons the more than three million members who put their trust in Blue Cross every day Blue Cross and Blue Shield of Alabama will remain strong and steadfast ready to serve today tomorrow and well into the future

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