Blue Essentials SM, Blue Advantage HMOSM, Blue PremierSM and MyBlue HealthSM - Provider Manual

Please access the latest version of the Blue EssentialsSM, Blue Advantage HMOSM, Blue PremierSM and MyBlue Health 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, Blue Premier and MyBlue Health Networks.

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, Blue Premier and MyBlue Health Download Section
Cover Page 
Table of Contents  
A. Support Services 
B. Provider Roles and Responsibilities –

 

 

C. Authorization Process  
D. Referral Notification Program 
E. Prior Authorization and Case Management 
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 
M. Employee Retirement System of Texas (ERS) Participants Benefit Plan using Blue Essentials Network 
Appendix – Terms, Definitions and Rules