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Specialty Pharmacy Prior Authorization Updates
Effective for dates of service on and after January 1, 2021, some specialty pharmacy codes from current or new clinical criteria documents will be included in our precertification review process.
Rituxan Biosimilars Medical Step Therapy Notice
January 1, 2021, the following specialty pharmacy drugs and corresponding codes from current Clinical Criteria will be included in our medical step therapy precertification review process.
Updates to AIM Clinical Appropriateness Guidelines for Radiation Oncology
The following updates will apply to the AIM Specialty Health Clinical Appropriateness Guidelines for Radiation Oncology for claims with dates of service on and after March 14, 2021. AIM Specialty Health is an independent company providing utilization review service on behalf of BlueChoice HealthPlan.
Clinical quality — Medical record collection update
Due to COVID-19, Healthy Blue has decided not to collect medical records on-site for HEDIS^®^ measurement year (MY) 2021. We are dedicated to protecting the health of both our associates and your staff and patients.
HEDIS tips — Asthma Medication Ratio
To continue improving HEDIS^®^ scores for the Asthma Medication Ratio (AMR), we have identified two areas that can greatly affect scores - Ensure proper coding and Educating your patients.