Blue cross community health plans provider manual april 2020 4 key contact information the provider manual is a reference for contracted providers to use while working with bcbsil. In support of the blue cross blue shield of michigan mission to offer access to health care coverage to everyone. If you have any questions or did not find the information you want, contact a provider network representative at. Blue cross and blue shield of minnesota provider policy and procedure manual 11152018 1 summary of changes 2018 chapter 1 at your service date topic changes type of changes. Find out how to register to submit electronic claims to wellmark, and learn what happens after you submit a claim. General helpful information please do not give your national provider identifier npi, tax id number or provider location id to a member to call provider customer service. Help patients with a different blue cross and blue shield plan. This provider manual will present a general overview of information regarding key administrative areas. Blue cross blue shield association medicare advantage. The bcbsil provider manual is a comprehensive guide for ppo, hmo and bluechoice select professional and facility providers. Hmo medical service agreement highlight and process.
Our hope is that blue book will make it easier for you and your staff to collaborate with us in providing excellent service to your blue cross nc patients. The information on this page serves as a reference only. This bimonthly publication provides news, suggestions and tools that make it easier for you to do business with humana. The provider resources section on our website provides access to many useful forms, as well as links to our provider publications and manuals. Fep maintains affordable rates while providing federal employees access to the same stateoftheart programs that 86 of the fortune 100 companies. Blue cross and blue shield of illinois, a division of health care service corporation, a mutual legal reserve company, an independent licensee of the. The blue cross blue shield association bcbsa announced feps enhanced benefits and competitive rates as open season for federal employees to choose 2015 health insurance coverage is set to begin. Member handbook blue cross blue shield of michigan. Cms manual system, list of medicare telehealth services, pub. Blue cross and blue shield of illinois provider manual. Here you will find information for assessing coverage options, guidelines for clinical utilization management, practice policies, the provider manual and support for delivering benefits to our members. Providers who have questions may refer to the following chart for a listing of additional resources and related. The provider manual sets forth the detailed polices, procedures and requirements for the participation of the professional contracting providers under the ppo contracts. Additional referral information appears in the bcn advantage and behavioral health chapters of the manual the online bcn provider manual is updated regularly.
Provider blue book blue cross blue shield of north carolina. Blue cross complete provider manual pdf blue cross blue shield. Click provider manuals on the right side of the homepage. Providers are instructed to refer to the michigan medicaid provider manual, msa bulletins and other relevant policy for specific coverage and reimbursement policies. For bcn hmo members admitted at any time and for bcn advantage members admitted through may 31, 2019 postacute care admissions. Introduction to blue plus blue plus manual 110717 introduction to blue plus general overview the blue plus provider manual is a general guide for participating primary care clinics pccs business office staff. The unitedhealthcare community plan care provider administrative guide has been approved by the state of kansas. Tpl insurance carrier id list by name montana medicaid provider.
The blue cross blue shield association is an association of 36 independent, locally operated blue cross andor blue shield companies. Medicare advantage providers anthem offers a variety of medicare plans to support member needs. Blue cross and blue shield of michigan bcbsm including united auto. Please refer to the original provider alert posted 10312018 for additional information. Aetna behavioral health refers to an internal business unit of aetna. Acupuncture acu audiology and hearing aids aud chiropractic chr durable medical equipment and medical supplies dme medical transportation mtr orthotics and prosthetics oap psychological services psy. General billing rules, claim forms, authorization process, information on medicare and other insurance liability. Submitting authorization requests to bcn pdf for bcn advantage members admitted on or after june 1, 2019 postacute care services. Updates are designated within the chapters as blue dot. Per the terms of the participation agreement, all providers are required to adhere to all policies and procedures contained in this manual, as applicable. If we make any procedural changes, in our ongoing efforts to improve. Additional instructions are available by clicking this link.
Aetna is the brand name used for products and services provided by one or more of the aetna group of subsidiary companies aetna. We also support our providers with access to information about our plans and member benefits, news and updates, training materials and guides and other helpful resources. The manual is organized into the following sections for your convenience. If you are an outofstate provider, for more information, please visit. This handbook gives an overview of your health care coverage. September 20, effective january 1, 2014 december 14, 1014. Blue cross and blue shield of minnesota provider policy and procedure manual 1115 2018 1 summary of changes 2018 chapter 1 at your service date topic changes type of changes. Provider manual chapters blue cross blue shield of michigan. Applied behavior analysis provider manual chapter four of the medicaid services manual issued october 21, 2014 claimsauthorizations for dates of service on or after october 1, 2015 must use the applicable icd.
Sep 21, 2015 anthem bcbs medicare provider services. Nov 2, 2014 2014 fall seminars contracted providers last chance. You will periodically receive updates to this manual. Credentialing 2014 molina healthcare medicaidhealthy michigan plan manual page 3 of 37 11. Payments to providers and medical records copy service vendors are made weekly.
January 1, 2018 cms, mi and participating plans execute an amended threeway contract. Blue cross blue shield of michigan telemedicine medical policy. Aetna is the brand name used for products and services provided by one or more of the aetna group of. Social security numbers ssns from all medicare cards by april 2019. This member handbook will help you and your family get the most from your health plan. The electronic medicaid provider manual contains coverage, billing, and reimbursement policies for medicaid, healthy michigan plan, childrens special health care services, maternity outpatient medical services moms, and other healthcare programs administered by the michigan department of health and human services mdhhs. Blue cross blue shield of michigan and blue care network are nonprofit corporations and independent licensees of the blue cross and blue shield association.
To be eligible, the practitioner must have maintained a primary care practice in good standing for a minimum of the most recent five years without any gaps in work history. Select blue cross blue shield of michigan provider manuals. Provider manuals blue cross blue shield of montana. By being wellinformed, youll have the confidence and security of knowing that health care coverage is available when you need it. Purpose of this manual this provider manual is intended for missouri carecontracted participating medicaid providers. Anthem blue cross and blue shield is the trade name of rocky mountain hospital and medical service, inc. Blue cross nc is pleased to provide the webbased edition of the blue book, our provider reference manual. The purpose of the bcbsaz advantage provider operating guide is to communicate expectations and set forth policies and procedures as an administrative tool for providers and office staff.
Medicare plus blue ppo manual blue cross blue shield of. On april 1, 2014, public health law section 25 was amended to promote linkage and retention in care for. Provider relations state of michigan feb 2, 2018 enrolled for medicare and payer id 7777777. Learn how to submit various types of claims, and how to check eligibility and benefits, and claims status. Bluecross blueshield of tennessee is a qualified health plan issuer in the health insurance marketplace.
Anthem blue cross and blue shield provider manual co page 1 of 179 revised. General reimbursement information refer to the covid19 preparedness page for temporary information related to servicing members in response to covid19. Community plan care provider manuals for medicaid plans by. Medicaid provider manual mdhhs website for details on covered. This manual is intended to support all entities and individuals that have contracted with anthem. Provider manual for physicians, hospitals and healthcare providers july 9, 2019.
Commonwealth of kentucky ky medicaid provider billing may 1, 2014 commercial insurance coverage this does not include medicare. Many of the provisions dont apply to providers in other states. Hmo medical service agreement highlight and process summary. General reimbursement information blue cross blue shield. Key changes index for provider and facilities manual. Walmart through arkansas blue cross blue shieldblue advantage administrators. Nonprofit corporations and independent licensees of the blue cross and blue shield association.
If you have questions about blue cross medicare advantage, please call our customer service number at 18777748592 ttytdd users should call 711. You can identify blue dot changes by a bluedot icon accompanied by a brief explanation of the change in a bold blue text box. July 1, 2014 page 6 of 91 teamwork with our fellow associates, we can expect and are expected to demonstrate a collaborative approach in the way we work. Updates are designated within the chapters as blue dot changes. Reminders regarding medical records processing and payments. Many of the provisions do not apply to providers in other states. Blue cross and blue shield of illinois provider manual blue. It is a comprehensive reference guide for our products, valueadded programs and services. Feb 2, 2018 carc 119 and remittance advice remark code rarc n640. Individual medicare advantage membership moves to new claims processing system january 1, 2015. The feeforservice provider manual provides detailed information for those applying for ahcccs applicants, members, potential and existing providers.
Provider blue book blue cross blue shield of north. If you need an older version of an administrative guide or care provider manual, please contact your provider advocate. Thank you for choosing blue cross blue shield of michigan. Filling out the cms1500 0212 blue cross blue shield. Liaison meetings below is the medicaid dmepos liaison meeting schedule for 2019. Blue cross blue shield association is an association of independent blue cross and blue shield companies.
Jan 27, 2020 bulletins and manuals navigation tool. Providers who have questions may refer to the following chart for a. This manual provides information for your carefirst bluecross blueshield and carefirst bluechoice, inc. This manual details our referral process, quality standards, credentialing and reimbursement process. Important information about medicare plans 1996 blue cross blue shield of michigan and blue care network are nonprofit corporations and independent licensees of the blue cross and blue shield association. Blueshield association sen i o r m ar ke t s 2018 medicare advantage and prescription drug plans offered by blue cross and blue shield companies. Tips for noncontracted providers outside of michigan.
Meridianchoice provider manual 2020 revised 1 2020. Provider information wellmark blue cross blue shield. Hmo medical service agreement highlight and process summary section. This provider manual is subject to change by blue cross on an ongoing basis. To find the contact information for your provider advocate, go to find a network contact opens in a new window, and then select your state. The manual is organized into the following sections. Provider claims and payment wellmark blue cross blue shield. Apr 01, 2020 2014 physicians health plan 1400 east michigan avenue lansing, mi 48912 517. We hope that this manual will make your interaction and collaboration with. Our hope is that the blue book will make it easier for you and your staff to. To search the manual, providers should complete the following steps. Indiana, kentucky, michigan, minnesota, new jersey, new mexico, new york. The online bcn provider manual is updated regularly. The care management chapter of the bcn provider manual serves as your comprehensive guide to referring members for specialty care.
Medicare plus blueppo manual revised april 1, 2020 1 provider manual chapter for medicare plus blue ppo note. Mdhhs information specific to different providers michigan. Effective january 1, 2014, bcbsnc no longer administers the medicare. Nucc instruction manual for cms1500 0212 claim form 1. Filling out the cms1500 0212 blue cross blue shield of. The use of provider within this manual refers to entities and individuals contracted with anthem that bill on a cms 1500. January 1, 2019 cms, mi and participating plans execute an amended threeway contract. This emanual contains information providers need to administer bcbsncs. For providers participating in the blue cross and blue shield of north carolina blue cross nc provider network blue cross nc is pleased to provide the webbased edition of the blue book, our provider reference manual. Telemedicine technologies in the practice of medicine april 2014, page 3. The following documents comprise the michigan medicaid provider manual and. Remember to secure all attachments per instructions. The following resources are designed to provide you with information needed to administer blue cross and blue shield of texas bcbstx plans for your patients including provider manuals and. Medicare pffs manual blue cross blue shield of michigan.
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