Medical Policies and Coverage

  

Effective April 28, 2021, medical drug policies will begin to move from this page to the Prior Review and Limitations page. Affected policies will remain in both locations temporarily but will be primarily located on the Prior Review and Limitations page once the review of all medical drugs has been transitioned to the new process. Please submit all requests for the affected policies to the CMM Portal or fax to 1-888-348-7332. View additional updates on the medical drug review process transition.

Medical Policies

Search for medical policies and guidelines and get policy updates.

Prior Review

Find prior review, or prior plan approval, requirements and instructions for requesting prior review

Important information regarding medical necessity reviews

Appeals

See instructions for filing an appeal and get answers to frequently asked questions.

Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members

Search requirements for BlueCard eligible members