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BCBSNE Provider Procedures
General
General
1500 Paper Claim Submission
Confidentiality of Substance Use Disorder Patient Records Rule (42 CFR Part 2)
Appointment Availability and Access Standards
BlueCard®: Electronic Provider Access
Accreditation
Step Therapy Reform Act
HITECH Act
Changes of Address, Telephone Number
Risk Adjustment
BlueCard®: Adjustments
Administrative Disputes
Remittance Advice
Ancillary Claim Submission (Billing) Guidelines
Coverage and Eligibility Verification for BlueCard® Members
Consumer Safety and Transparency
BlueCard® and Medicare
Network Termination and Non-Payable Status
Provider Responsibilities and Considerations
Provider Audit and Special Investigations Unit (SIU) – Standard Review Policy
ID Card Number and Prefix
Tax Levy and Garnishment
Preventive Health and Wellness
Preauthorization and Precertification
Hold Harmless and Balance Billing
Pharmacy – Formulary Focused on Safety and Low Net Cost
Federal Employee Program and Medicare
Complaint Investigation and Process
Network Termination Appeal
Network Termination – Second Level of Appeal
Process to Appeal SIU Sample Audit Findings
Process to Appeal Post-Payment Provider Audit Findings
Network Termination – First Level of Appeal
Network Termination - Non-Appealable Decisions
Member Benefit Appeals
BlueCard®: Appeals
Application for Reinstatement following Network Termination or Non-Payable Status
Contiguous Area Claim Filing
Assignment of Benefits
Audiology Testing
Provider Audit Program
Prepayment Audit
Post-Payment Audit
Blue Distinction Centers (BDC)
Coordination of Benefits (COB) for BlueCard®
Coordination of Benefits
Jail or Prison Benefits
Preventive Care Benefits
Federal Employee Health Benefits Program
BlueCard®: Limited Benefits Products
Billing – Claim Submission
Biofeedback
Birth Doula Services
Claim Filing for BlueCard® Members
BlueCard
®
: Claim Payment
BlueCard®: How to Identify International Members
Utilization Management for BlueCard® Members
Provider Financial Responsibility for Pre-Service Review for BlueCard® Members
Products Included in BlueCard®
Products Excluded from the BlueCard® Program
BlueCard®: Member ID Cards
How the BlueCard® Program Works
Cardiac Rehabilitation
Identification Cards
Continuity of Care
Facility Standards for Practitioner Offices, Urgent Care Facility Standards, Medical Record Documentation Standards
NICU Inpatient Level of Care
Cash Discounts
Name Change – Facility/Clinic
Split-Year Claim Submission
Corrected Claims
Electronic Claims Submission
Returned Claims
Submission of Claims
Clinical Quality Management
Closing Practice to New Patients
Waiver of Deductible/Coinsurance/Copayment
Workers’ Compensation
Federal Employee Program: Waiver Copy Required for Denial Review
Member Responsibility – Cost Sharing
Dietary Counseling
Filing for Non-Covered Services
Non-Discrimination
Peer-to-Peer Discussion
Documentation
Outpatient Prescription Drugs
Mental Health Providers: Dual License
Durable Medical Equipment
Electronic Funds Transfer
Federal Employee Program – Pharmacy
Verification of Enrollment
Health Fairs
Immediate Family
Sliding Fee Schedule
Fertility Testing/Treatment
Timely Filing Limit
Mental Health Provider Levels
Pharmacy – How to Request Preauthorizations
Tax Identification Number – Multiple Locations
Independent Sleep Lab
Independent Labs
Inpatient Psychiatric Sessions
Language Interpreter or Translation Services
Special Investigations Unit (SIU)
Multiple “Pay-to” Locations
Locum Tenens
Utilization Review/Management
Medical Necessity
Medical Records Standards
Provision of Services
Scope of Practice
Refund Offsetting
On-Site Review
Participation Requirements
Payment
Specialty Pharmacies
Physical Presence
Readmission Quality Program
Reconsideration Requests
Referrals
Refund Requests
Subrogation
Telehealth
Teleservices