Blue Essentials SM (formerly known as HMO Blue TexasSM), Blue Advantage HMOSM and Blue PremierSM Physicians, Professional Providers, Facility and Ancillary Providers - Provider Manual

Please access the latest version of the Blue EssentialsSM, Blue Advantage HMOSM and Blue PremierSM Physicians, Professional Providers, Facility and Ancillary Providers - Provider Manual below. This manual was developed to provide you and your staff with administrative guidelines with respect to the Blue Essentials, Blue Advantage HMO and Blue Premier Networks.

From the table of contents, you can view and print content by section. This manual will be updated, as needed, and these updates will be posted to this site. These files are in a PDF format and require Adobe Reader to open and view them.

If you have trouble opening the files or accessing the information, please contact your Network Management office for additional options in receiving the latest version of this manual.

Blue Essentials, Blue Advantage HMO and Blue Premier Download Section
Cover Page 
Table of Contents and Welcome  
A. Support Services 
B. Provider Roles and Responsibilities  
C. iExchange 
D. Referral Notification Program 
E. Preauthorization 
F. Filing Claims 
G. Quality Improvement Program 
H. Disease Management Programs, Case Management Program, Clinical Practice Guidelines, and Bridges to Excellence 
I. Behavioral Health Services 
J. Other Information 
K. Hospital Acquired Conditions and Serious Reportable Events 
L. Pharmacy