Provider Manual

Thank you for browsing our online Provider Manual. If you have any questions or comments about the information found here, please contact us.

Helpful Contact Information and Other Valuable Resources

• Provider Assistance
• Blue Cross Contact Information
• Blue Cross Addresses
• EDI Services
• Electronic Funds Transfer/Direct Deposit
• Glossary of Terms
• Network Services
• Online Courses
• Provider News and Updates
• Website Links

Claims Processing and Operational Information

• The Alabama Child Caring Program
• Assistant Surgeon Claims
• Blood Collection Fee - Venipuncture
• CMS Old 1500
• CMS New 1500
• Coordination of Benefits (COB) and Subrogation
• Consultations vs. Referrals
• Co-surgeons and Team Surgeons
• Destruction of Benign or Premalignant Lesions
• Guidelines for Coverage of Diabetes Self-Management Education (DSME) Programs
• Diagnosis Codes
• Diagnosis Coding for Screening Test
• Diagnostic Radiology
• Filing a Hardcopy Claim
• Immunization Administration for Vaccines/Toxoids
• Influenza Vaccine
• Injectable Drugs
• Instructions on Management of Varicose Veins
• Maternity Services When Total (or Global) Obstetrical Care is Not Provided
• Modifiers
• Multiple Surgical Procedures
• New Patient vs. Established Patient
• Non-Covered Services
• Obstetrical Global Fees
• Preventative Care Benefits
• Procedure Codes
• Professional and Technical Components of X-rays
• Referring Physician Information
• Refund Requests and Overpayments
• Sleep Disorder Clinics
• Supplies and Equipment Provided Through the Physician's Office
• Time Limits for Filing Claims
• Type of Service Codes

Enrollment

• Enrollment/Credentialing
• Maintenance
• Recredentialing

Medical Policy

• Blue Cross and Blue Shield of Alabama Medical Policies

Precertifications and Reviews

• Precertifications and Reviews
• Precertification of Advanced Imaging Services
• Precertification Forms
• Pre-Service Appeals and Concurrent Appeal Process

Preferred Care and Participating Programs

• Locum Tenens/Covering Physicians
• Medical Record Documentation
• Physician In-Office Clinical Laboratory Procedures (Exhibit I)
• Physician Referrals Out of Network
• Physician Treating Members of Same Family/Household
• Preferred Medical Doctor Program
• Preferred Medical Laboratories
• Professional Courtesy Discounts
• Provider Profiles and Surgical Episodes Reports

Primary Care Network (PCN) Information

• Covering Physicians Required
• Mental and Nervous Services Provided by a Primary Care Physician
• Overview of Benefits for Alabama Personal Choice
• PCN Referral Criteria Guidelines
• Referrals for Emergency Treatment
• Referrals vs. Precertification
• Retroactive Referrals and Non-PMD Referrals
• Specialist and Primary Care Network Patients

Special Instructions for Specialty Networks

• Preferred DME
• Preferred Home Health
• Preferred Occupational Therapy
• Preferred Physical Therapy

Disclaimer

The following disclaimer is applicable to all telephone inquiries and automated communications systems (i.e., telephone and fax) to Blue Cross and Blue Shield of Alabama:

The information provided is only general benefit information and is not a guarantee of payment. Benefits are always subject to the terms and limitations of the plan and no employee of Blue Cross and Blue Shield of Alabama has authority to enlarge or expand the terms of the plan. The availability of benefits is always conditioned upon the patient’s coverage and the existence of a contract for plan benefits as of the date of service. A loss of coverage, as well as contract termination, can occur under certain circumstances. There will be no benefits available if such
circumstances occur.