Coverage policy: Additional information
What is the BlueAdvantage Administrators of Arkansas Coverage Policy for Walmart?
Coverage Policy means a statement developed by BlueAdvantage Administrators of Arkansas that sets forth the medical criteria for coverage under the Walmart Associates’ Health Plan.
The existence of an affirmative BlueAdvantage Administrators of Arkansas Coverage Policy for Walmart does not certify coverage as it does not override or replace the requirement of medical necessity for the particular individual.
The absence of a specific BlueAdvantage Administrators of Arkansas Coverage Policy for Walmart does not indicate that a service is covered. For example, a new device or a new use of an old device may not have been proven safe and effective, but coverage may also have not been previously requested, thereby providing us with an opportunity to study the information on the safety and effectiveness of the new use of the device.
A copy of a specific BlueAdvantage Administrators of Arkansas Coverage Policy for Walmart is available upon request at no cost from BlueAdvantage Administrators of Arkansas.
How Are Coverage Decisions Made?
The BlueAdvantage Administrators of Arkansas medical directors review each existing Coverage Policy annually for accuracy.
The following sources of information are consulted for the development of Coverage Policies regarding new or emerging treatments, procedures, devices or drugs:
- Member’s Benefit Certificate or Summary Plan Description: Is this service, procedure or drug specifically excluded?;
- FDA Status: Does the service, device or drug require FDA Approval?;
- Assessment of the effectiveness and safety published by:
- Agency for Healthcare Research and Quality;
- American Hospital Formulary Service and/or Clinical Pharmacology and/or NCCN Compendia;
- Cochrane Library of Systematic Reviews;
- Formal technology assessment committees of national medical societies;
- Hayes, Inc. Technology Assessment;
- Results of Phase III clinical trials as published in peer-reviewed, mainstream medical journals;
- Position papers of major medical organizations;
- Consultation with medical experts
A similar process is followed for additional new uses of established procedures, devices or drugs to establish Coverage Policies.