Effective for dates of service on or after July 1, 2019, the following drug code from the current clinical guideline will be included in our specialty pharmacy pre-service clinical review process.

Please note: inclusion of NDC code on claims will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.

Pre-service clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM®), a separate company.  

 

Clinical Guideline

HCPCS Codes

NDC Codes

Drug

CG-THER-RAD-03

A9699, C9408

71258-0015-02, 71258-0015-22

Azedra®



Featured In:
April 2019 Anthem New Hampshire Provider Newsletter