Contraceptive Medication Requests
Issue: #398 DEC2017
Due to changes in preventive benefits, providers are encouraged to contact Provider Services to verify coverage of contraceptives prior to sending the Contraceptive Medication Management Request form.
The Preventive Health Benefits, as defined under the Patient Protection and Affordable Care Act (ACA) may result in more plans providing contraceptive coverage.
The form is located on our website at http://bit.ly/2AXBYN8.
Incomplete forms will be returned.
To ensure prompt and accurate processing of your request:
- Include the following required information:
- Benefit plan number
- Patient name
- Patient date of birth
- Patient diagnosis
- Name of the contraceptive
- Provider name
- Provider NPI
- Allow up to 15 days for review. If you do not receive a response to the original request after 15 days, contact Provider Services at 800-368-2312. Do not submit duplicate requests.
- Approved requests are valid for five years if the member continues coverage with Blue Cross Blue Shield of North Dakota (BCBSND). A new request is not required until after the initial approval has expired.