Acthar Gel
Patients
Payors

Parsons, Bob

Member ID: BC98765432
Benefit Verification
Complete
Prior Authorization
Pending
Patient Information
Patient Name
Parsons, Bob
Member ID
BC98765432
Date of Birth
05/12/1975
Phone
(555) 123-4567
Address
123 Main St, Anytown, CA 94123
Date Opened
03/01/2024
Prescription Information
Prescribing Physician
Dr. John Smith
Medication
Acthar Gel
Strength
40mg/0.4mL
Frequency
1 / Day / 30 Days
Actions
Insurance Information
Insurance Provider
Blue Cross
Medical Condition
Dermatomyositis
Member ID
BC98765432
Benefit Verification Summary
Coverage Tier
Tier 3
Patient Cost
$150/month
Auth Duration
6 months
Requires Prior Auth
Yes
Review Time
3-5 business days
Fax Number
555-123-4567
Timeline
  • Prior Authorization Pending
    Prior authorization for Acthar Gel needs to be submitted to Blue Cross
    2/15/2026
  • Benefit Investigation Completed
    Verified coverage for Acthar Gel with Blue Cross
    03/10/2024
  • Patient Record Created
    Initial patient record created for Parsons, Bob
    03/01/2024
  • Patient Chart Received
    Patient chart and medical records uploaded to system
    03/01/2024
  • Referral Form Received
    Acthar Gel referral form received from physician
    03/01/2024