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Arkansas Blue Cross and Blue Shield is committed to ensuring that Federal Employee Program (FEP) members receive high-quality health care that is consistent with evidence-based, nationally recognized clinical criteria and guidelines. Accordingly, we are implementing a change in the way we manage prior authorization for FEP members. This new program will be administered by Magellan Rx Management. On February 21, 2022, providers began contacting Magellan Rx to obtain prior authorizations for the in-scope drug for FEP members for dates of service on or after March 1, 2022. Providers directly contracted with Arkansas Blue Cross and Blue Shield may create an online account for Prior Approvals at Magellan Rx Provider Portal. For urgent or expedited requests call Magellan Rx at 800-443-5709.
Magellan Rx Management is the pharmacy division of Magellan Health.
The program will apply to members enrolled in the following plans:
The effective date of this program is March 1, 2022.
The list of medications included in the Medical Pharmacy Program is updated at least annually.
Prior authorizations are required for medications administered at the following places of service:
Providers may call Magellan Rx for authorization requests at 800-443-5709.
If the provider is contracted directly with Arkansas Blue Cross and Blue Shield, non-urgent authorizations also may be done through the secure Magellan Rx secure provider portal at www.mrxgateway.com.
To expedite prior authorizations, the provider should have the following information:
If requested by Magellan Rx, the provider should be prepared to upload the following documents to the Magellan provider portal or to fax the following documents to Magellan Rx’s Health Insurance Portability and Accountability Act (HIPAA)-compliant fax:
Note: It is the responsibility of the ordering provider to obtain prior authorization before services are provided. If the ordering provider and the rendering provider are different, the rendering provider is responsible for ensuring
that the appropriate approval is on file, prior to rendering services.
Providers directly contracted with Arkansas Blue Cross and Blue Shield may request access to the Magellan Rx provider portal. To do so, visit Magellan Rx’s provider portal at www.mrxgateway.comand complete the following steps:
Please have the following information ready:
No. Magellan Rx provider portal users linked to the practice tax ID number will be able to conduct transactions for every network clinician linked to the practice tax ID number.
Magellan Rx has been engaged only to oversee utilization management. Claims should be submitted to Arkansas Blue Cross and Blue Shield.
Yes. The claim for the rendering provider will be denied. Rendering providers need to make sure a prior authorization is on file with Magellan Rx before administering the medications to members. When prior authorization is required but was not obtained, providers can follow instructions on the Explanation of Benefits (EOB) to submit a claim appeal, as applicable.
Providers and their staff will have the opportunity to obtain prior authorizations to help streamline medication administration and service.
Note: Magellan Rx initial clinical reviewers are clinical pharmacists.
Yes. In most cases, approvals can be made based on the initial information provided by the requestor. If there is a question or concern regarding the information provided, the case will be sent to a pharmacist who will reach out to the requesting provider. If the pharmacist cannot reach an agreement regarding the appropriate course of treatment with respect to the requested medication, the case will be escalated to a Magellan Rx physician. A Magellan Rx physician will discuss the case with the provider, and they will make a mutual decision, in accordance with plan guidelines, on an appropriate course of action.
The ordering provider, rendering provider (if different from ordering) and member receive copies of the final determination notices.
Magellan Rx approvals link providers by their tax ID number. When approvals are entered into Arkansas Blue Cross and Blue Shield cross claims system, they will be attached to all network providers who share that tax ID number.
Providers who are directly contracted with Arkansas Blue Cross and Blue Shield must be signed into their account page on the Magellan Rx provider portal at www.mrxgateway.com.
If the request is made by phone, the requestor should provide this information to the Magellan Rx Management team.
All rendering providers are required to check the Magellan Rx provider portal to confirm a prior authorization has been issued prior to administering a medication that is part of this program.
The outpatient facility will receive a copy of the approval letter and can view the status of the approval via Magellan Rx’s provider portal www.mrxgateway.com.
To view a prior authorization, providers directly contracted with Arkansas Blue Cross and Blue Shield must be signed into their Magellan Rx provider portal account at www.mrxgateway.com:
If a provider has any questions, he/she should contact Magellan Rx directly at 800-443-5709.
After an approval is generated, a change in dose and/or frequency may be requested via phone by Magellan Rx at 800-443-5709.
The approval duration or validity period of a prior authorization is dependent on the medication and is not negotiable.
There is one prior authorization number per medication. However, Magellan Rx can process multiple requests via a single portal session or telephonic request.
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