Access to more claim denial information is now self-service

Effective for dates of service on and after April 1, 2021, the following specialty pharmacy drugs and corresponding codes from current Clinical Criteria noted below will be included in our medical step therapy precertification review process. Step therapy review applies upon precertification initiation or renewal in addition to the current medical necessity review.

 

Clinical Criteria	Status	Drug(s)	HCPCS codes
ING-CC-0011	Nonpreferred	Ocrevus®, injection, 1 mg	J2350
ING-CC-0160	Nonpreferred	Eptinezumab, injection 1 mg	J3032

 

The Clinical Criteria is publicly available on our provider website. Visit the Clinical Criteria website to search for specific Clinical Criteria.

 

What if I need assistance?

If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative.

 

 

ABSCRNU-0193-20