Understand how to submit drugs using NDC’s and information on certain drugs. Also refer to the National Drug Codes Billing Tools for Contracted Providers for a units calculator and reimbursement information located on our provider website home page.
-
- Home
- Network Participation
Network Participation
- Claims and Eligibility
Claims and Eligibility
- Claims and Eligibility
- BlueCard Program
-
Electronic Commerce
- Eligibility and Benefits
-
Utilization Management
- Prior Authorization Services For Fully Insured and ASO
- Prior Authorizations Lists for Blue Cross Medicare Advantage (PPO) and Blue Cross Medicare Advantage (HMO)
- Prior Authorizations Lists for Designated Groups
- Recommended Clinical Review Option
- Prior Authorization Exemptions (Texas House Bill 3459)
-
Claims Filing Tips
- Claim Status
- Claim Review Process
- Interactive Voice Response (IVR) System
- Medicare Advantage Private Fee-for-Service (PFFS)
- Eligibility and Benefits Inquiry (HIPAA 270/271)
- Education and Reference Center
- Clinical Resources
Clinical Resources
- Carelon (formerly AIM) Effective March 1, 2023
- Clinical Resources
- Behavioral Health Care Management Program
- Clinical Practice Guidelines
- Quality Care – Partner With Your Patients
- eviCore Prior Authorization Program
- Special Beginnings - Maternity Program
- Preventive Care Guidelines/Patient Wellness Guidelines
- Quality Improvement Tip Sheet
- Telemedicine and Telehealth Services
-
Health Equity and Social Determinants of Health (SDoH)
- Pharmacy Program
- Standards and Requirements
Standards and Requirements
- Standards and Requirements
-
Affordable Care Act (ACA)
-
Clinical Payment and Coding Policies
-
Disclosure Notices
- Federal Employee Program (FEP)
-
General Reimbursement Information
-
Manuals
- Medical Policies
- Medical Policy and Pre-certification/Pre-authorization Information for Out-of-Area Members
-
Consolidated Appropriations Act and Transparency in Coverage Final Rule
- Employers
- Producers
- Providers
- Company Information