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