Specialty Pharmacy Submission

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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.
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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/TennCar
eSelect 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
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Specialty Pharmacy Submission
Select the appropriate Specialty Pharmacy
Procedure Codefrom 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 sameas the requesting provider.
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Specialty Pharmacy Submission
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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 immediateonline
authorization.
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Specialty Pharmacy Submission
If BlueCross BlueShield of Tennessee Medical
Policy Criteria are not applied, supporting
information is required here andthe
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
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 authorizationnumber 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?