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Disclosure Notices
Code Auditing Upgrade & Modifier 59 Exempt Auditing - eff 9/21/09
Quarterly Drug and Home Infusion Drug Fee Schedule Updates effective 9/1/09 have been posted under Reimbursement Schedules as of 6/1/09
Fee Schedule Update
Evidence Based Reimbursement

What's New
July 4 Holiday Schedule
Electronic Refund Management (ERM) is here!
Code Auditing Upgrade & Modifier 59 Exempt Auditing - eff Sept 21, 2009
Medical Policy Medical Records Documentation Guidelines - Revised
Not Otherwise Classifed J- Codes Update- June 2009
Care Comparison Data Collection Form
Facility Out-of-Network Care Enrollee Notification Form Effective June 1, 2009 - Harris County
Evidence Based Reimbursement
Are You Billing for Compound Drugs?
Coming Soon: Discontinuance of the Paper Provider Claim Summary (PCS)
Swine Flu Alert
Ancillary Discharge Notification Form - Update
Bridges to Excellence
Availity Participating Provider Training Webinars - June 2009

Provider Education

Blue Review
Distribution date of May 29, 2009

Blue Review
Issue 1 - 2009

Blue Review Archives
   
Electronic Commerce
  		• Alerts
  		• Availity L.L.C.
  		• eCare/NDAS Online
  		• EDI Format Specifications
  		• EDI Transactions
  		• EFT/ERA Forms
  		• Electronic Funds Transfer (EFT)/Electronic Remittance Advice (ERA)
  		• Explore Paperless Possibilities
  		• HIPAA
  		• Online Transaction Tip Sheets
  		• RealMed

     
    Provider Library
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  		• BlueCompare for Physicians
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  		• Bridges to Excellence
  		• Claim Appeal/ Reconsideration Review Process & Billing Dispute External Review Process (BDERP)
  		• Claim Pointers
  		• Evidence Based Measures
  		• FAQs
  		• Learn More About
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         • Terms and Conditions
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  		• National Provider Identifier
  		• Physician Advisory Committee (PAC)
  		• Provider Manuals Requires password for access
  		• Reference Guides
  		• Special Investigations Tutorial
  		• Time to be Blue
  		• Welcome Provider - Online Orientation
  		• Wellness Initiatives/Programs
    General Reimbursement Information

  • Bundling Information Requires password for access
    • Clear Claim Connection
     
  		• Recoupment/Refund Requires password for access
     
  		• Schedules Requires password for access
     
  		• Significant Edits Requires password for access
     
  		• ...and more... Requires password for access

    Medical Policy

  • Draft Medical Policies

  • Active/Pending Medical Policies

     
  		• Medical Policy Medical Records Documentation Guidelines (Predeterminations/Claims)

    Credentialing/
    Contracting
  		• Ten Great Reasons to be Blue
  		• Provider Record/ Credentialing
  		• Consent to Assignment of Provider Contracts (Change of Ownership-CHOW)

    UM/QI/Medical Management

  • Behavioral Health Medical Necessity Criteria

  • iEXCHANGE®
  		• Clinical Practice and Behavioral Health Guidelines
  		• Postpartum Depression - The “Andrea Yates Bill”
  		• Radiology Quality Initiative/Preauth Prgm
  		• Step Therapy Guidelines for City of Houston (COH)
     
  		• Wellness Guidelines
    		 
    Pharmacy
  		• Digitek Recall
  		• Medicare Part D Updates
  		• Medicine Safety Project
  		• Override Request (pdf - 18k)
  		• Preferred Drug Guide
  		• Proton Pumps (pdf - 28k)
  		• Quantity vs. Time
  		• Specialty Programs
    • Triessent
    • Factor Drugs (Accredo)
    • Lupron (TAP Pharmacy   Solutions)
  		• Step Therapy/Prior Authorization
  		• Synagis
  		• Topical Verapamil

    Provider
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  		• Be Smart. Be Well.TM
    • Address Childhood
      Obesity Epidemic
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      Announcement
  		• Blue Distinction
  		• Electronic Refund Management (ERM) is here!
  		• Hospital Comparison Tools
    • Consumer
    • Professional Requires password for access
  		• Obesity Management Tool Kit Web Site


     
     
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