Supporting Health Care Providers
As a health care provider, you’re an integral part of our team. Our online tools give you all the information you need to understand how a patient’s health benefits support their care.
Get Information About Benefits
Log in to the My Insurance Manager Provider Portal to get complete coverage information, prior authorization requirements, as well as deductibles and payment responsibility.
File a Claim and Get Payment
Learn about the tools you have to submit claims and receive payments.
Pharmacy Information
BSA's preferred pharmacy benefit manager is OptumRx, a pharmacy care services company creating smarter health care connections to help more than 65 million Americans realize improved care, lower costs, and a better overall experience.
The following applies to members with BSA’s pharmacy benefit coverage with OptumRx.
Log into My Health Toolkit, then Pharmacy Benefits for drug pricing information, drug list tool and the most up-to-date drugs for the following prescription drugs and other information:
- Lowest Cost Net Formulary - Also referred to as the Preferred Drug List, applies to most of our benefit plans, with just a few exceptions.
- Specialty Drugs - Features drugs that are used to treat complex or chronic medical conditions.
- $0 Covered Drug - The Affordable Care Act (ACA) requires most health plans to cover certain drugs at no cost to members.
- Prior Authorization - Applies to prescription drugs that require prior authorization.
- Drug Management Programs
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Quantity Management - This program limits the amount we cover for certain drugs. We provide medical necessity exceptions for some of these limits when you request and receive prior authorization for them.
Step Therapy - Step therapy requires members to try cost-effective “First Choice” medications before trying (or “stepping up to”) more expensive “Second Choice” medications. We provide medical necessity exceptions when you request and receive prior authorization for them.
- Specialty Medical Medications
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Specialty medications often are covered under the medical benefit. They can be costly for our members, and not all plans cover them the same way. That’s why it’s important to review whether the use of these medications meets coverage criteria before a specialty drug is provided.
The program also includes requirements for self-administered drugs and site-of-care that may impact coverage, which is important to know if you provide these types of medications.
Medical Drug List - View this list to find out which medical specialty drugs require prior authorization under the Specialty Medical Benefit Management (SMBM) program.
Self-Administered Specialty Drugs - View this list to view self-administered specialty drugs.