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Hospital Policies

1. Will Blue Advantage follow Medicare guidelines for the “inpatient only” procedures? Yes, facilities should file claims for Blue Advantage members to Blue Cross and Blue Shield of Alabama just as you would file them to Medicare Part A.

2. How are claims filed for distinct units, i.e. rehabilitation, psychiatric or swing bed? Claims for Blue Advantage members should be filed to Blue Cross using the same methods/codes used to file to Medicare Part A.

3. How do Blue Advantage claims appear on the remittance? Payment for Blue Advantage members will be posted on Blue Cross’ weekly remittance notices under the section titled “Blue Advantage.”

4. Are preadmission certifications required for Blue Advantage members? Current Utilization Review Program (CURP) facilities should treat these members as any other Blue Cross and Blue Shield of Alabama member when admitting. Preadmission certification is not mandatory, however, we do encourage non-participating and non-CURP facilities to do a courtesy preadmission certification when a Blue Advantage member is hospitalized.

5. Will providers receive a return to provider (RTP) report for errors? Yes.

6. How will rehabilitation services be paid in the outpatient hospital setting? These claims (physical therapy, occupational therapy and speech therapy) will process with a copayment per visit for Blue Advantage participating facilities. The amount of the copayment will be determined by the benefit option under which the member is covered.

7. If a patient has TWO admissions during the same benefit period, will they owe copayments for each admission? Depending on the Blue Advantage option the member has chosen, there is only one copayment for each benefit period regardless of the number of admissions. Refer to online benefits for copayment amounts and benefit period information.