Capital blue pegol print 2025

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The document is a preauthorization request form for Certolizumab Pegol (Cimzia®), used to treat conditions such as moderate-to-severe rheumatoid arthritis, Crohn's disease, active ankylosing spondylitis, and active psoriatic arthritis. It includes sections for general information, member and provider details, clinical criteria for initial authorization and reauthorization, and dosing information. The form requires documentation of previous treatments and their outcomes, as well as testing for latent tuberculosis.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (138 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is another name for Highmark insurance?

Highmark began operations on December 6, 1996, conducting business in Western Pennsylvania as Highmark Blue Cross Blue Shield and in the rest of Pennsylvania as Pennsylvania Blue Shield, partnering with three Blue Cross plans to provide complete coverage.

Is the Highmark Blue Cross the same as the Capital Blue Cross?

Two independent companies operate in central Pennsylvania, Highmark Blue Shield in Pittsburgh and Capital Blue Cross in Central Pennsylvania.

Are blue cross and capital blue cross the same?

Capital Blue Cross is an independent licensee of the Blue Cross Blue Shield Association.

Is Capital Blue Cross the same as Anthem?

BCBS Companies STATE/TERRITORYAVAILABLE COMPANIES California Anthem Blue Cross Blue Shield of California Colorado Anthem Blue Cross and Blue Shield Colorado Connecticut Anthem Blue Cross and Blue Shield Connecticut Delaware Highmark Blue Cross Blue Shield Delaware48 more rows

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