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

Shop Plans
Member Support
Partner Resources
About Us