Lowe's - Prior Certification Required for Specialty Drugs
In March 2010, Lowe's Companies, Inc. began utilizing Care Continuum, an independent utilization management company, for prior certification of specialty drugs and specialty drug claim management.
Lowe's is a Blue Cross and Blue Shield (BCBS) National Account, with medical/PPO-plan members in every state. If you provide care for Lowe's members who may require specialty drugs, follow these steps to help expedite the claim process:
- Confirm membership—Lowe's plan members can be identified by the following BCBS alpha prefixes: LWE, LHN.
- Verify eligibility and benefits, and complete any other applicable pre-service requirements. Check the back of the member's ID card for important details and contact information.
- Check the list of specialty drugs requiring prior certification .
- Contact Care Continuum at (866) 240-4734 for prior certification of specialty drugs administered in your office, clinic or in the member's home.
- Include the National Drug Code (NDC) for the drug you are billing on your claim, along with the applicable HCPCS or CPT code.
- Submit all claims and claim status inquiries to Blue Cross and Blue Shield of Texas (BCBSTX).
If you are currently providing care for a Lowe's plan member and have not submitted a prior certification request for the administration of a specialty drug in your office, clinic or in the patient's home, call Care Continuum to obtain prior certification. Please note that the Lowe's medical plan requirement follows mandatory prior certification guidelines. Failure to comply could result in financial penalties for the member.
If you have any questions concerning this change contact Care Continuum at (866) 240-4734.
Care Continuum is an independent third party vendor and is solely responsible for its services and products. BCBSTX makes no endorsement, representations or warranties regarding any services or products offered by this vendor. If you have any questions, you should contact Care Continuum directly.
Verification of eligibility and/or benefit information is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member's eligibility and the terms of the member's certificate of coverage applicable on the date services were rendered.