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Provider News

  • Pharmacy Benefit Manager Change to IngenioRx

    August 19, 2019 – Effective October 1, 2019, IngenioRx will become the pharmacy benefit manager (PBM) for prescription drugs, home-delivery pharmacy and specialty pharmacy for Healthy Blue members. IngenioRx, Inc. is an independent company providing pharmacy benefit management services on behalf of BlueChoice...

  • MCG Care Guidelines Update and Customizations

    August 12, 2019 – Effective November 1, 2019, customizations will be implemented for Chemotherapy and Inpatient & Surgical Care (W0162) for adult patients.

  • Clinical Criteria Web Posting Q1 2019

    July 29, 2019 – On February 22, 2019, and March 14, 2019, the Pharmacy and Therapeutic (P&T) Committee approved the following Clinical Criteria applicable to the medical drug benefit for Healthy Blue. These policies were developed, revised or reviewed to support clinical coding edits.

  • Missing Notification/Late Notification Process Reminder

    July 25, 2019 – Effective September 1, 2019, failure to obtain prior authorization or to notify Healthy Blue within the established guidelines as outlined below will result in an administrative denial. For our participating providers, this is a contractual obligation and has been in effect since the execution of your...

  • New Healthy Blue Website, Same Valuable Healthy Blue Information

    July 15, 2019 –– We are pleased to unveil our new Healthy Blue public website — It’s our latest upgrade in communications and provides all of the same useful Healthy Blue content to which you are accustomed but with an all-new look and feel that will further enhance your provider experience.

  • Prior Authorization Requirements for Hyperbaric Oxygen and Supervision of Hyperbaric Oxygen Therapy

    July 8, 2019 – Effective October 1, 2019, prior authorization (PA) requirements will change for hyperbaric oxygen and supervision of hyperbaric oxygen therapy to be covered by Healthy Blue. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including...

  • SC Opioid Treatment Programs (OTP) Guideline

    July 3, 2019 – Opioid Treatment Programs (OTPs) provide evidence-based medication-assisted treatment (MAT) for members with Opioid Use Disorder (OUD). OTPs utilize multi-disciplinary staff who provide services utilizing pharmacological, physiological, and psychotherapeutic interventions to stabilize, prevent withdrawal...

  • Quarterly Pharmacy Formulary Change Notice Effective August 1, 2019

    July 2, 2019 – The formulary changes listed in the Quarterly Pharmacy Formulary Change Notice table were reviewed and approved at the first quarter Pharmacy and Therapeutics Committee meeting.

  • BlueBlast – July 2019

    July 1, 2019 – July 2019 issue of BlueBlast. BlueBlast is sharing some insight for our providers and their office staff that we hope will help you reduce stress in your practices. We met Dennis McIntee at a conference in South Carolina several years ago. McIntee is a gifted keynote speaker and author who travels across...