NC BCBSNC Prior Review/Certification Faxback Form 2014 free printable template

INTRO ARTICULAR HYALURONATE INJECTIONS PRIOR REVIEW/CERTIFICATION FATBACK FORM INCOMPLETE FORMS MAY DELAY PROCESSING ALL NC PROVIDERS MUST PROVIDE THEIR 5DIGIT BCB SNC PROVIDER ID# BELOW PRESCRIBER

How to fill out NC BCBSNC Prior ReviewCertification Faxback Form

How to fill out NC BCBSNC Prior Review/Certification Faxback Form

1. Obtain the NC BCBSNC Prior Review/Certification Faxback Form from the official website or your provider portal.
2. Enter your patient's information, including their name, BCBSNC member ID, and date of birth at the top of the form.
3. Fill in the requesting provider's information, such as name, NPI number, and contact details.
4. Indicate the specific services or procedures being requested for prior review.
5. Attach any relevant clinical documentation required for the review process.
6. Double-check that all information is accurate and complete to avoid delays.
7. Fax the completed form and documentation to the designated number as indicated on the form.
8. Follow up with the BCBSNC office if you do not receive confirmation of your fax submission.

Who needs NC BCBSNC Prior Review/Certification Faxback Form?

1. Healthcare providers who require prior authorization for certain services or procedures for their patients enrolled in BCBSNC plans.
2. Patients needing pre-approval for specific medical services to ensure coverage under their BCBSNC insurance.

People Also Ask about

What is CPT code J7321?

J7321 Hyaluronan or Derivative, Hyalgan or Supartz, For Intra-Articular Injection, Per Dose. J7323 Hyaluronan or Derivative, Euflexxa, For Intra-Articular Injection, Per Dose. J7324 Hyaluronan or Derivative, Orthovisc, For Intra-Articular Injection, Per Dose. 2. HCPC's code J7325 is defined as 1 mg.

What is J7325 used for?

HCPCS code J7325 for Hyaluronan or derivative, Synvisc or Synvisc-One, for intra-articular injection, 1 mg as maintained by CMS falls under Miscellaneous Drugs .

What is the purpose of the Synvisc injection?

SYNVISC is a viscosupplement injection that supplements the fluid in your knee to help lubricate and cushion the joint, and can provide up to six months of osteoarthritis knee pain relief with three injections.

Does Euflexxa require prior authorization?

The following Hyaluronic acid products do not require an authorization prior to use: Durolane®, Supartz FX®, Euflexxa® and Gelsyn-3®. Consider using these products first.

How do I bill CPT J7325?

Coding Guidelines When this injection is administered either unilaterally or bilaterally the injections would be billed by placing J7325 in item 24 (FAO-09 electronically) and listing the total number of mg's administered in the units field. There are 2 different products that are billed using this code.

What is CPT J7323?

J7323. HYALURONAN OR DERIVATIVE, EUFLEXXA, FOR INTRA-ARTICULAR INJECTION, PER DOSE. J7324. HYALURONAN OR DERIVATIVE, ORTHOVISC, FOR INTRA-ARTICULAR INJECTION, PER DOSE.

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What is NC BCBSNC Prior Review/Certification Faxback Form?

The NC BCBSNC Prior Review/Certification Faxback Form is a document used by North Carolina Blue Cross Blue Shield to request pre-authorization or certification for certain medical services or procedures before they are performed.

Who is required to file NC BCBSNC Prior Review/Certification Faxback Form?

Healthcare providers and facilities that wish to obtain pre-authorization for specific medical services for patients covered by NC BCBSNC are required to file the NC BCBSNC Prior Review/Certification Faxback Form.

How to fill out NC BCBSNC Prior Review/Certification Faxback Form?

To fill out the NC BCBSNC Prior Review/Certification Faxback Form, providers need to include patient demographics, details of the requested service, medical history, and any relevant supporting documentation. It should be completed accurately and submitted through the appropriate fax channels.

What is the purpose of NC BCBSNC Prior Review/Certification Faxback Form?

The purpose of the NC BCBSNC Prior Review/Certification Faxback Form is to ensure that patients receive medically necessary services and that those services are covered under their health insurance plan before they are administered.

What information must be reported on NC BCBSNC Prior Review/Certification Faxback Form?

The NC BCBSNC Prior Review/Certification Faxback Form must report information such as patient name, insurance details, service codes, diagnosis codes, clinical justification for the procedure, and any additional relevant information that supports the need for the service.