Blue cross blue shield healthcare plan of georgia, inc. Overview blue shield of ca provider blue shield of california. Aug 1, 2020 administrative anthem blue cross anthem and availity electronic data interchange edi is excited to. Blue cross medicare advantage ppo provider manual february 2021 11 section 3. Mar 1, 2021 mcg care guidelines 24th edition customization. Mar 01, 2021 anthem blue cross and blue shield is the trade name of. Anthem blue cross and anthem blue cross life and health insurance company are independent licensees of the blue cross association. Blue cross community centennial provider reference manual updated on sept. When selecting a blue distinction center, please confirm the blue distinction center facility or provider is in your health plan network. When updates to the provider manual are made, new directions makes every effort to communicate these changes to providers and. Blue cross blue shield of massachusetts, and then click update favorites.
The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that the blue cross and blue shield service benefit plan covers or pays for. Anthem blue cross and blue shield provider manual co. Dec 07, 2020 provider manuals bulletins and manuals navigation tool. Blue cross senior secure plan i hmo h0564047 by anthem blue cross san bernardino county, ca. Federal employee program fep blue cross and blue shield of alabama. Date topic changes type of changes content new topic deletions topic deleted.
In colorado rocky mountain hospital and medical service, inc. Anthem blue cross and blue shield is the trade name of rocky mountain hospital and medical service, inc. Learn about blue shields protocols for coordinating the treatment of mental health and substance abuse disorders between behavioral health providers and primary care physicians. Feb 20, 2007 because blue plus is an affiliate of blue cross, blue plus is subject to most of the sa me policies and procedures. All changes and updates will be updated and posted to the molina medical website at. Blue cross blue shield of michigan and blue care network are nonprofit corporations and independent licensees of the blue cross and blue shield association. The mhc medical provider practitioner manual has been consolidated to now cover all counties in which mhc provides medical managed care services. The update includes information on functionality to submit medical records requested by anthem via availity that was not available when the 2018 provider manual was originally posted. Here you will find the anthem provider manuals, guidelines for clinical utilization management um, medical policies and coding spotlights for common conditions. Access blue shield of california and blue shield of california promise health plan procedure manuals. The manual includes enhanced content and should be helpful in understanding the bluecard program that enables members of one blue plan to obtain health care service benefits while traveling or living in another blue plans service. Blue plus primary care clinics should refer to the blue plus provider manual for specific blue plus guidelines.
This guide discusses how rebranding impacts providers and their patients. Members can contact our customer service department or the department of managed health care, which protects hmo customers, by telephone at its tollfree number, 18884662219, or at a tdd number for the. If your billing address is different than your site address you must click add new address and repeat steps 1422 to add your billing address. Provider bulletin january 2021 livehealth online is an independent company providing telehealth services on behalf of anthem blue cross. As information is updated by the blue cross blue shield association andor anthem blue cross, we will. Blue cross and blue shield of minnesota provider policy and procedure manual 05202019 1 summary of changes 2019 chapter 1 at your service. View or download our online reference manual for blue cross nc providers. Blue cross community centennial provider reference manual as of april 30, 2020.
Blue cross senior secure plan i hmo california medicare. Updated and improved provider manual for anthem blue cross. Members who have been receiving care from a health care provider may have a right to keep their provider for a designated period of time. Provider manuals bulletins and manuals navigation tool.
Anthem blue cross anthem is committed to supporting you in providing quality care and services to the members in our network. The policies contain information regarding claims submission, medical necessity guidelines, and other information to assist in filing of claims to blue cross of idaho. Anthem blue cross electronic attachments x12 275 5010 page 1 of 2 california provider communications anthem blue cross electronic attachments x12 275 5010 published. Provider participation in the california medical dental program. Box 22702 long beach, ca 90801 compliance and fraud alertline if you suspect cases of fraud, waste, or abuse, you must report it to molina. Anthem blue cross of california offers affordable medicare, medicaid, medical, dental, and vision insurance. In fact, anthem blue cross was one of the first medical managed care organizations mcos. The manual is for physicians, hospitals, ancillary providers and facilities participating in any florida blue network. Careanthem blue cross member, you have the right to. Sep 28, 2018 anthem blue cross and blue shield anthem recently updated the claim inquiryadjustment filing tips section of our online provider manual. The manual can be used as a reference guide for university of utah health plans u of u health plans policies and procedures for commercial and government plans. In addition to the instructions in this section and other sections of the manual, contracting provider shall adhere to the following.
Anthem blue cross and blue shield provider manual co page 1 of 186 revised. Mar 1, 2021 dme checklist of information needed from providers. Anthem blue cross and blue shield provider and facility manual. Health care provider tools blue cross and blue shield of. Mar 1, 2021 medical policies and clinical utilization management guidelines update. The guide includes information on our products, services and valueadded programs. Weve dedicated a covid19 provider faq at for temporary policy changes related to claims, coding, enrollment and other policy changes during the covid19. Anthem blue cross cal mediconnect plan is a health plan that contracts with both medicare and medical to provide benefits of both programs to enrollees.
Cross name and symbol are registered marks of the blue cross association. This provider manual is subject to change by blue cross on an ongoing basis. For general information about blue plus, you may refer to chapter 6 of this manual. Providers who have questions may refer to the following chart for a listing of additional resources and related.
Molina healthcare of california molina healthcare or molina. Weve designed tools that health care providers find useful. Blue cross community centennial provider reference manual as of may 1, 2020. This provider manual is designed for anthem cross contracted providers. Anthem provides health care professionals with supporting resources to help your relationship with us run as smoothly as possible. Blue cross and blue shield of illinois, a division of health care service corporation, a mutual legal reserve company, an independent licensee of the. September 2014, effective december 15, 2014 november 14, 2015 anthem blue cross and blue shield provider and facility manual anthem blue cross and blue shield is the trade name of rocky mountain hospital and medical service, inc. The blue cross provider policy and procedure manual, along with the blue plus manual, provides key administrative information including the quality improvement program, the um program, quality standards for participation and claims appeals.
Nov 15, 2019 provider manual updates november 15, 2019 blue cross blue shield of texas bcbstx makes periodic updates and clarifications related to operational changes and regulatory mandates to the provider manual, processes and policies and procedures that you comply with as a network provider. The formulary, pharmacy network, andor provider network may change at any time. Blue cross blue shield of michigan medicare plus bluesm ppo. At blue cross and blue shield of oklahoma bcbsok, we are committed to providing support to physician practices. September 20, effective january 1, 2014 december 14, 1014. Be sure to check your coverage manual to find out if you must go to a blue distinction center for certain procedures to be covered. The anthem blue cross bluecard program provider manual. Dec 01, 2020 this updated bluecard provider manual will replace the current bluecard provider manual effective march 1, 2021. Blue cross blue shield of michigan medicare plus bluesm. Independent physician and provider manual blue shield of ca. Claims for the analysis of a lab must be filed to the. In virginia, carefirst medplus is the business name of first care, inc.
Anthem blue cross and blue shield provider manual co page 1 of 179 revised. The blue cross name and symbol are registered marks of the blue cross association. Table of contents blue cross and blue shield of illinois. Mar 31, 2021 view our provider administration manuals as discussed in our provider contracts, these manuals are your source for important information about our policies and procedures.
Provider manual molina healthcare of california molina healthcare or molina molina marketplace product effective 712017 molinas health benefit exchange product is now known as the molina marketplace product. Jul 22, 2016 blue cross of california nonroutine survey followup report july 22, 2016. Provider reference manual blue cross and blue shield of. Anthem blue cross has a longstanding history of providing medical services to californians. Determined by blue cross to be required to diagnose or treat an illness or injury, help a malformed part of the body work better, or keep the condition from becoming worse. This manual is a reference tool to help contracting delegates and their staff understand how to perform delegated functions to aetna standards. Find policies and procedures for directcontract blue shield network providers. Anthem blue cross and anthem blue cross life and health. Provider policy and procedure manual pdf blue cross mn. January 2021 provider manual change notification letter pdf, 49 kb. Nov 17, 2020 the university of utah provider manual is intended for use by physicians, ancillary providers, and contracted facilitiesvendors as well as their practice managers and office staff. Provider practitioner manual has been consolidated to now cover all counties in which mhc. Medical interface manual blue shield of ca provider. Medical policies blue cross and blue shields federal.
Providerpractitioner manual has been consolidated to now cover all counties in which mhc. Molina healthcare of california molina healthcare or. Provider manual updates blue cross and blue shield of texas. Blue cross community centennial provider reference manual as of march 31, 2021. Blue cross community health plans provider manual february 2021 4 key contact information the provider manual is a reference for contracted providers to use while working with bcbsil.
Because blue plus is an affiliate of blue cross, blue plus is subject to most of the same policies and procedures. Hmo ipamedical group procedures manual find policies and procedures for blue shield ipas, medical groups and their contracted providers. Anthem blue cross is the trade name of blue cross of california. Anthem blue cross partnership 2 of 3 stars adult plan customer service people got the help they needed from plan customer service and plan written materials. Important information regarding the use of this manual.
Acupuncture acu audiology and hearing aids aud chiropractic chr durable medical equipment and medical supplies dme medical transportation mtr orthotics and. Also, please note that bcbsnc, and other blue cross andor blue shield plans, may provide available information concerning an individuals status, eligibility for benefits, andor level of benefits. This provider bulletin is an update about information in anthem blue cross. Independent physician and provider manual this manual describes administrative guidelines, policies, and procedures for directcontact blue shield network providers of healthcare services for members of our health plans. Access our procedure manuals and benefit guidelines. Welcome to the florida blue manual blue cross and blue shield of florida, inc. Medical decisions relative to medical technologies are to be made strictly by memberspatients in consultation with their health care providers. Change notifications january 2021 blue shield promise cal mediconnect provider manual change notification letter pdf, 120kb.
Sm, sm1 marks of blue cross and blue shield of north carolina. A division of health care service corporation, a mutual legal reserve company, an independent licensee of the blue cross and blue shield association. Whether doing research or streamlining billing, these tools can help you. Blue cross and blue shield of illinois provider manual. Blue shield of california promise health plan is an independent licensee of the blue shield association. Our goal is to create a useful reference guide for you and your. Preferred durable medical equipment dme supplier manual. Thank you for participating in molina healthcare of california s mhcs provider network and partnering with us to deliver high quality services to our members. March 2021 anthem blue cross provider news california. Medical provider manuals california department of health. Our latest podcast explores how teams of healthcare providers in michigan are working together to treat the whole person, both mind and body, and the impact of this integrated approach on health and healthcare costs.
The provider manual contains the policies, procedures, reference information, and minimum care standards required of blue shield promise providers. Molina healthcare of california marketplace provider manual any reference to molina members means molina marketplace members. Anthem blue cross ancillary provider manual august 2009 exhibit. Independent physician and provider manual blue shield of ca provider independent physician and provider manual this manual describes administrative guidelines, policies, and procedures for directcontact blue shield network providers of healthcare services for members of our health plans. Download provider manuals for professionals, facilities, and others for more on our programs and policies. Anthem blue cross and blue cross of california partnership plan, inc.
The bluecard program horizon blue cross blue shield of. Hmo plans are provided by blue cross and blue shield of texas, which refers to ghs insurance. The plan offers national innetwork prescription coverage. Provider reference manual blue cross and blue shield of new. Blue cross of california california department of managed. Blue cross community centennial provider reference manual updated on may 1, 2020.
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