General

1500 Paper Claim Submission

Confidentiality of Substance Use Disorder Patient Records Rule (42 CFR Part 2)

BlueCard®: Electronic Provider Access

Appointment Availability and Access Standards

Accreditation

Step Therapy Reform Act

HITECH Act

Changes of Address, Telephone Number

Risk Adjustment

BlueCard®: Adjustments

Administrative Disputes

Remittance Advice

Ancillary Services Management: Specialty Pharmacy, Durable/Home Medical Equipment, and Independent Labs

Ancillary Claim Submission (Billing) Guidelines

ID Card Number and Prefix

Consumer Safety and Transparency

Provider Responsibilities and Considerations

Preventive Health and Wellness

Preauthorization and Precertification

Hold Harmless and Balance Billing

Complaint Investigation and Process

Tax Levy and Garnishment

Provider Audit and Special Investigations Unit (SIU) – Standard Review Policy

BlueCard® and Medicare

Federal Employee Program and Medicare

Coverage and Eligibility Verification for BlueCard® Members

Network Termination and Non-Payable Status

Pharmacy – Formulary Focused on Safety and Low Net Cost

Network Termination – First Level of Appeal

Network Termination Appeal

Process to Appeal SIU Sample Audit Findings

Process to Appeal Post-Payment Provider Audit Findings

Network Termination – Second Level of Appeal

Network Termination - Non-Appealable Decisions

BlueCard®: Appeals

Member Benefit 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)

Jail or Prison Benefits

Preventive Care Benefits

BlueCard®: Limited Benefits Products

Federal Employee Health Benefits Program

Coordination of Benefits (COB) for BlueCard®

Coordination of Benefits

Billing – Claim Submission

Biofeedback

Birth Doula Services

How the BlueCard® Program Works

Products Included in BlueCard®

Products Excluded from the BlueCard® Program

Provider Financial Responsibility for Pre-Service Review for BlueCard® Members

BlueCard®: How to Identify International Members

Claim Filing for BlueCard® Members

Utilization Management for BlueCard® Members

BlueCard®: Member ID Cards

BlueCard^®: Claim Payment

Cardiac Rehabilitation

Identification Cards

Continuity of Care

NICU Inpatient Level of Care

Facility Standards for Practitioner Offices, Urgent Care Facility Standards, Medical Record Documentation Standards

Cash Discounts

Name Change – Facility/Clinic

Split-Year Claim Submission

Returned Claims

Submission of Claims

Electronic Claims Submission

Corrected 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

Scope of Practice

Provision of Services

Refund Offsetting

On-Site Review

Participation Requirements

Payment

Physical Presence

Readmission Quality Program

Reconsideration Requests

Referrals

Refund Requests

Subrogation

Telehealth

Teleservices