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. General reimbursement information refer to the covid19 preparedness page for temporary information related to servicing members in response to covid19. If you have any questions or did not find the information you want, contact a provider network representative at. Additional referral information appears in the bcn advantage and behavioral health chapters of the manual the online bcn provider manual is updated regularly. Credentialing 2014 molina healthcare medicaidhealthy michigan plan manual page 3 of 37 11. Liaison meetings below is the medicaid dmepos liaison meeting schedule for 2019. Filling out the cms1500 0212 blue cross blue shield. This handbook gives an overview of your health care coverage. On april 1, 2014, public health law section 25 was amended to promote linkage and retention in care for. 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. Mdhhs information specific to different providers michigan. This manual is intended to support all entities and individuals that have contracted with anthem. Blue cross blue shield association medicare advantage.
Telemedicine technologies in the practice of medicine april 2014, page 3. Select blue cross blue shield of michigan provider manuals. 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 plus blue ppo manual blue cross blue shield of. You will periodically receive updates to this manual. Key changes index for provider and facilities manual. Additional instructions are available by clicking this link. Aetna behavioral health refers to an internal business unit of aetna. Blue cross blue shield of michigan telemedicine medical policy. It is a comprehensive reference guide for our products, valueadded programs and services. Medicare pffs manual blue cross blue shield of michigan. Individual medicare advantage membership moves to new claims processing system january 1, 2015. General reimbursement information blue cross blue shield. The bcbsil provider manual is a comprehensive guide for ppo, hmo and bluechoice select professional and facility providers.
Reminders regarding medical records processing and payments. Nov 2, 2014 2014 fall seminars contracted providers last chance. Blue cross complete provider manual pdf blue cross blue shield. Sep 21, 2015 anthem bcbs medicare provider services.
Bluecross blueshield of tennessee is a qualified health plan issuer in the health insurance marketplace. Remember to secure all attachments per instructions. Provider blue book blue cross blue shield of north. Help patients with a different blue cross and blue shield plan. 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. Payments to providers and medical records copy service vendors are made weekly. Thank you for choosing blue cross blue shield of michigan. Per the terms of the participation agreement, all providers are required to adhere to all policies and procedures contained in this manual, as applicable. 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.
Purpose of this manual this provider manual is intended for missouri carecontracted participating medicaid providers. 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. Providers who have questions may refer to the following chart for a listing of additional resources and related. The blue cross blue shield association is an association of 36 independent, locally operated blue cross andor blue shield companies. If we make any procedural changes, in our ongoing efforts to improve. This member handbook will help you and your family get the most from your health plan.
For bcn hmo members admitted at any time and for bcn advantage members admitted through may 31, 2019 postacute care admissions. 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. Commonwealth of kentucky ky medicaid provider billing may 1, 2014 commercial insurance coverage this does not include medicare. Anthem blue cross and blue shield provider manual co page 1 of 179 revised. The manual is organized into the following sections for your convenience. Our hope is that the blue book will make it easier for you and your staff to. Feb 2, 2018 carc 119 and remittance advice remark code rarc n640. Tpl insurance carrier id list by name montana medicaid provider. This bimonthly publication provides news, suggestions and tools that make it easier for you to do business with humana. Blue cross and blue shield of illinois, a division of health care service corporation, a mutual legal reserve company, an independent licensee of the. This guide is not meant to be allinclusive and is subject to change. Provider manual chapters blue cross blue shield of michigan. Community plan care provider manuals for medicaid plans by. Hmo medical service agreement highlight and process summary section.
Filling out the cms1500 0212 blue cross blue shield of. Medicare advantage providers anthem offers a variety of medicare plans to support member needs. Aetna is the brand name used for products and services provided by one or more of the aetna group of subsidiary companies aetna. The care management chapter of the bcn provider manual serves as your comprehensive guide to referring members for specialty care. If you are an outofstate provider, for more information, please visit. 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. General billing rules, claim forms, authorization process, information on medicare and other insurance liability. The provider manual sets forth the detailed polices, procedures and requirements for the participation of the professional contracting providers under the ppo contracts. Jan 27, 2020 bulletins and manuals navigation tool. The medical provider manual explains the process to submit claims, describes the payment process, and provides a wealth of other information. Medicare plus blueppo manual revised april 1, 2020 1 provider manual chapter for medicare plus blue ppo note. This emanual contains information providers need to administer bcbsncs. Provider relations state of michigan feb 2, 2018 enrolled for medicare and payer id 7777777.
The provider resources section on our website provides access to many useful forms, as well as links to our provider publications and manuals. If you have questions about blue cross medicare advantage, please call our customer service number at 18777748592 ttytdd users should call 711. Provider blue book blue cross blue shield of north carolina. Indiana, kentucky, michigan, minnesota, new jersey, new mexico, new york. Aetna is the brand name used for products and services provided by one or more of the aetna group of. 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. 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. Nucc instruction manual for cms1500 0212 claim form 1. January 1, 2018 cms, mi and participating plans execute an amended threeway contract. 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. Provider information wellmark blue cross blue shield.
Submitting authorization requests to bcn pdf for bcn advantage members admitted on or after june 1, 2019 postacute care services. 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. The following documents comprise the michigan medicaid provider manual and. Provider claims and payment wellmark blue cross blue shield. Provider manuals blue cross blue shield of montana. 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. Updates are designated within the chapters as blue dot changes. Many of the provisions do not apply to providers in other states.
Apr 01, 2020 2014 physicians health plan 1400 east michigan avenue lansing, mi 48912 517. Many of the provisions dont apply to providers in other states. January 1, 2019 cms, mi and participating plans execute an amended threeway contract. Tips for noncontracted providers outside of michigan. Please refer to the original provider alert posted 10312018 for additional information. The manual is organized into the following sections. The feeforservice provider manual provides detailed information for those applying for ahcccs applicants, members, potential and existing providers. Anthem blue cross and blue shield is the trade name of rocky mountain hospital and medical service, inc.
Walmart through arkansas blue cross blue shieldblue advantage administrators. 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. The online bcn provider manual is updated regularly. To search the manual, providers should complete the following steps. The information on this page serves as a reference only. Provider manual for physicians, hospitals and healthcare providers july 9, 2019. The unitedhealthcare community plan care provider administrative guide has been approved by the state of kansas. September 20, effective january 1, 2014 december 14, 1014. You can identify blue dot changes by a bluedot icon accompanied by a brief explanation of the change in a bold blue text box. 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.
Get set up with all the right tools for working with wellmark. Meridianchoice provider manual 2020 revised 1 2020. 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. The use of provider within this manual refers to entities and individuals contracted with anthem that bill on a cms 1500. In support of the blue cross blue shield of michigan mission to offer access to health care coverage to everyone.
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. If you need an older version of an administrative guide or care provider manual, please contact your provider advocate. Member handbook blue cross blue shield of michigan. Blue cross and blue shield of illinois provider manual blue. Blue cross and blue shield of michigan bcbsm including united auto. 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.
Providers are instructed to refer to the michigan medicaid provider manual, msa bulletins and other relevant policy for specific coverage and reimbursement policies. Blue cross nc is pleased to provide the webbased edition of the blue book, our provider reference 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. Fep maintains affordable rates while providing federal employees access to the same stateoftheart programs that 86 of the fortune 100 companies. This manual details our referral process, quality standards, credentialing and reimbursement process. Blue cross blue shield association is an association of independent blue cross and blue shield companies. Blue cross and blue shield of illinois provider manual.
By being wellinformed, youll have the confidence and security of knowing that health care coverage is available when you need it. This manual provides information for your carefirst bluecross blueshield and carefirst bluechoice, inc. This provider manual is subject to change by blue cross on an ongoing basis. Updates are designated within the chapters as blue dot. Nonprofit corporations and independent licensees of the blue cross and blue shield association. Hmo medical service agreement highlight and process.
Cms manual system, list of medicare telehealth services, pub. Effective january 1, 2014, bcbsnc no longer administers the medicare. Medicaid provider manual mdhhs website for details on covered. Click provider manuals on the right side of the homepage. We hope that this manual will make your interaction and collaboration with. Social security numbers ssns from all medicare cards by april 2019. Anthem blue cross and blue shield provider and facility manual. Find out how to register to submit electronic claims to wellmark, and learn what happens after you submit a claim. Oct 16, 2019 oct 2, 2018 blue cross blue shield global core program receive the reasons why blue cross nc denied a request for treatment or health care commonwealth of kentucky ky medicaid provider billing apr 7, 2014 stayce towles updates appendix for scl2 procedure codes per. Providers who have questions may refer to the following chart for a.
Hmo medical service agreement highlight and process summary. Blue cross blue shield of michigan and blue care network are nonprofit corporations and independent licensees of the blue cross and blue shield association. Learn how to submit various types of claims, and how to check eligibility and benefits, and claims status. 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.