Blue Choice PPOSM and Blue High Performance Network® (BlueHPN®) - Provider Manual

Please access the latest version of the Blue Choice and BlueHPN - Provider Manual below. This manual was developed to provide you and your staff with administrative guidelines with respect to the Blue Choice PPO and Blue High Performance Network.

You can view and print content by section. This manual will be updated, as needed, and 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 these files or accessing the information, please contact your local Network Management Office to obtain the latest version of this manual.


Blue Choice PPO and Blue High Performance Network Download Section
Cover Page
Table of Contents and Welcome
A. Support Services
B. Provider Roles and Responsibilities

a. Network and ID Cards

b. Eligibility and Benefits

c. Roles and Responsibilities

d. Outpatient Lab and Radiology Guidelines

e. How to Join

f. Credentialing

C. Authorization Process
D. Referral Notification Program
E. Prior Authorizations & Case Management
F. Filing Claims

a. General Information

b. Prompt Pay

c. Billing Requirements

d. Claim Forms

e. Electronic Filing

f. Ancillary Services

g. Facility Services

h. Claim Review Process

G. Pharmacy
H. Federal Employee Program (FEP)
I. Behavioral Health Services
J. Quality Improvement Program
K. Disease Management Programs
L. Privacy of Health Information
M. Blue Distinction
N. Hospital Acquired Conditions/Serious Reportable Events
O. Rights and Responsibilities
Appendix – Terms, Definitions and Rules