Provider Manuals

Provider Manuals set forth the detailed policies, procedures, and requirements necessary for participation in our provider networks. We update these manuals as changes are needed and new information becomes available. Check here for the most current version.

BlueCard Program Provider Manual

Blue Cross Medicare Advantage HMO^SM Delegated

Blue Cross Medicare Advantage HMO Delegated Provider Manual
Medicare Advantage HMO Delegated Utilization Management and Population Health Management Plan
Medicare Advantage HMO ODAG Delegated Letter Templates

Blue Cross Medicare Advantage^SMHMO and PPO

Blue Cross Medicare Advantage HMO Non-Delegated Model Manual
Blue Cross Medicare Advantage (PPO) Manual

Commercial

The commercial manual applies to providers participating in our PPO and HMO commercial networks.

Behavioral Health Program
Billing and Reimbursement
Coordinated Home Care
Credentialing Standards
Durable Medical Equipment
Electronic Commerce
Extended Care
Fraud and Abuse
Health Care Medical Management
Glossary of Terms
HMO Claims Processing
HMO Coordination of Benefits

HMO Medical Service Agreement Highlight and Process Summary
HMO Membership Information
HMO Network Adequacy
HMO Payment/Compensation to the IPA
HMO Scope of Benefits
HMO Utilization Management Plan
Home Infusion Therapy
Hospice
MyBlue Plus POS
NCQA Accreditation Requirements
Network Policies and Procedures
Pharmacy Management
Quality Improvement

Medicaid

Blue Cross Community Health Plans^SM Manual
Blue Cross Community MMAI (Medicare/Medicaid Plan)^SMManual