Blue Cross Blue Shield of Texas - HMO Blue® Texas Online Orientation Check List

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HMO Blue^® Texas Online Orientation Check List

1.	BCBSTX Provider Web site - www.bcbstx.com/provider
2.	HMO Blue Texas Physician & Other Professional Provider – Provider Manual -under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual. Limited Provider Networks – if applicable (Section A) HMO Blue Texas ID Card (Section B) and link to Sample of “Standard” HMO Blue Texas ID Card PORG on ID Card Physician & other Professional Provider Roles & Responsibilities (Section B) Referrals Required (Section B) Filing Claims (Section F) Provider Customer Service – 1-877-299-2377

3.	HMO Blue Texas Quick Reference Guide (QRG) – under Provider Library, click on Reference Guides, then click on the offering – HMO Blue Texas Quick Reference Guide Review each column of the Quick Reference Guide: Major Characteristics Benefits, Eligibility, Claims Status & Verification Correspondence, Claim Appeals & Reconsideration Precertification – Click on HMO Blue Texas Precertification/Notification/Referral Requirements List(password protected-enter password) Laboratory & Radiology Services Behavioral Health

4.	iEXCHANGE - Automated Precertification & Referral System Web & IVR applications – Go to www.bcbstx.com/provider, under UM/QI/Medical Management, click on iEXCHANGE. On the iEXCHANGE Home page you can find information about the Web application as well as the Interactive Voice Response (IVR) phone system 1-800-413-0869. Also refer to the iEXCHANGE box on the left hand side of the Home page for the following information: How To Get Started with the iEXCHANGE Web Reference Guide IVR Reference Guide Precertification/Notification/Referral Requirements Lists IVR & Web Application Comparison Frequently Asked Questions iEXCHANGE Webinars Texas iEXCHANGE Support Desk – 1-800-441-9188, select 1, then select 4 Utilization Management Department – 1-800-441-9188, select 1, then select 3

5.	Laboratory Services – Go to www.bcbstx.com/provider, under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual, then select Section B or click on Laboratory Services to access the information on the Web site. LabCorp is the “exclusive” lab provider for HMO Blue Texas Reimbursable Lab Services List – if performed in physician’s office

6.	Radiology Services - Go to www.bcbstx.com/provider, under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual, then select Section B or click on Radiology Services to access the information on the Web site. Precertification is required for the following High tech outpatient diagnostic radiology procedures: CT/CTA scans, MRI/MRA scans, SPECT/Nuclear Cardiology studies and PET scans (excludes radiology services provided during emergency room visits, in-patient admissions, out-patient surgeries and 23 hour observation). For Precertification, just log onto AIM’s Provider Portal and complete the online questionnaire that identifies the reasons for requesting the exam or contact American Imaging Management (AIM) at 1-800-859-5299. *Note:* Requests for these procedures cannot be processed in the iEXCHANGE System. View the CPT Codes affected by this program.

7.	Filing Claims - Go to www.bcbstx.com/provider, under Provider Library, select Provider Manuals, (password protected-enter password), then under Manuals, click on HMO Blue Texas Physician & Other Professional Provider – Provider Manual, then select Section F. Electronic Claims - Availity – www.availity.com or 1-800-AVAILITY (282-4548) Claims Submission Proof of Timely Filing Clean Claim Information Claim Appeal/Reconsideration Review Process Refunds & Recoupments

8.	Filing Claims – For OBGyn Physicians OB Billing and Multiple Birth Guidelines

9.	Injectable Drug Program Go to www.bcbstx.com/provider, go to the Pharmacy* Section, then click on the “Injectable Drug Program” offering*

10.	HMO Blue Texas Provider Directory Go to www.bcbstx.com/provider, click on Provider Finder* in the Header bar*

11.	Changes Affecting Your Provider Record, Change in Your Status or Changes Affecting Your NPI Number, Added a New Office Location, Moved to a New Office Location? – *Call (972) 996-9610, press 3* or Go to www.bcbstx.com/provider, and click on ”Change Your Information”, complete the form and submit via online or print and fax it to the indicated number.

12.	Experience. Wellness. Everywhere.^SM – BCBSTX’ New Wellness Initiatives/ Programs Introduction to new BCBSTX’ Wellness Initiatives/Programs Blue Care Connection^® (Page 6) Program Overview Wellness Pads & Posters

13.	Review Home Page of BCBSTX Provider Web site Go to www.bcbstx.com/provider Provider Finder (2 areas) Provider Library (2 areas) Forms (2 areas) Electronic Commerce (2 areas) General Reimbursements (2 areas) password protected-enter password Blue Review (2 areas) Change Your Information NPI Refer to In-Network Providers Credentialing/Contracting UM/QI/Medical Management Pharmacy Provider Tools/Programs iEXCHANGE IVR/Web What’s New Disclosure Notices Workshop Schedule

14.	Review Secured Page of BCBSTX Provider Web site Go to www.bcbstx.com/provider Medical Policies Manuals Recoupments & Refunds Reimbursement Schedules & Related Information Bundling Information Provider Tools All Product News HMO Blue Texas Precertification/Notification/Referral Requirements Lists posted 7-2008