Does BMC HealthNet Plan have a set standard on the amount or limits of a supply of drugs?
The plan dispenses in 30-day supply increments. Can we bill more than one service on one claim? Yes. There can be multiple dates on one claim, but not a date range. See Section 10 of the Provider Manual for billing guidelines. Can we bill for multiple injections simultaneously? Yes, but it is required that the claim be submitted with a supplier’s invoice for each serum since this is the basis of pricing. How long does it take to have pre-authorization processed? See Section 3 of the Provider Manual for the utilization management timeline policy. If physicians practice at one site, why is there a need to use so many different provider numbers? The Plan uses the different ID numbers to identify the unique location of a medical record. This level of detail is required for HEDIS and other measures of Plan performance.
