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Lowe’s New Prior Certification for Specialty Drugs Update

January 10, 2012

We are delivering this message on behalf of Blue Cross® and Blue Shield® of Alabama. 

 
The Lowe’s Companies, Inc. medical plan option uses CareContinuum, an independent utilization management company, on all primary Lowe’s medical plan options to perform these services:

  • Prior Certification of Specialty Drugs
  • Specialty and Drug Claim Management

CareContinuum contracts directly with Lowe’s. CareContinuum is an independent company and is solely responsible.
 
Effective November 1, 2011, CareContinuum is revising the list of specialty drugs requiring prior certification. It is adding new drugs to this list.
 
When caring for Lowe’s medical plan members who require specialty drugs, remember to follow these steps:

  • Contact CareContinuum at 866-240-4734 for prior certification of specialty drugs administered in your office or in the member’s home. This number is also on the member’s insurance card. Get a list of drugs requiring prior certification at: www.carecontinuum.com/network/lowesspecialtydrug.htm.
  • When submitting a claim to Blue Cross and Blue Shield of Alabama, include the National Drug Code (NDC) of the drug you are billing.

If you have a current patient and have not submitted a prior certification for the administration of a specialty drug in your office, clinic or in the patient’s home, call CareContinuum to get prior certification. Please note the Lowe’s medical plan requirement should follow mandatory prior certification guidelines. Failure to comply could result in financial penalties for the medical plan member.
 
Providers must submit appeals of adverse determinations either orally or in writing by contacting CareContinuum directly:

Appeal Coordinator
1700 Eastpoint Parkway Suite 50
Louisville, Kentucky 40223
Phone: 866-240-4734
Fax: 877-540-6223
If you have questions concerning this change, contact CareContinuum at 866-240-4734.
 
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association.

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