Medical Reference Manual

  • Find valuable information on our business practices including claims processing, customer service, and general plan information.

  • Contact information, confidentiality, and appointment access
    • Contact information - plans and departments
    • Service teams - where to obtain assistance
    • Confidentiality policy
    • Appointment access standards for providers

    Contact information, confidentiality, and appointment access (12-1-2017)

    Ancillary
    • Types of service covered
    • Claims and billing
    • Home based services - home health and hospice, medical equipment, infusion
    • Prosthetics/Orthotics
    • Alternative Care Services

    Ancillary (12-1-2017)

    BlueCard® and Shared Administration
    (formerly NASCO)
    • BlueCard® Program
    • Shared Administration

    BlueCard and Shared Administration (12-1-2017)

    Claims submission and payments
    • Submitting claims
    • CMS 1500 completion
    • Reimbursement
    • Explanation of Payment
    • Statement of Overpayment Recoveries

    Claims submission and payments (12-1-2017)

    Coding and billing guidelines
    • Coding types and sources
    • Special billing situations
    • Most commonly used modifiers
    • NDC code billing guidelines

    Coding and billing guidelines (12-1-2017)

    Credentialing and contracting
    • Credentialing process
    • Contracting process
    • Terminating a contract
    • Credentialing and claims
    • Confidentiality
    • Information/address changes

    Credentialing and contracting (12-1-2017)

    ID cards
    • FEP ID cards

    ID cards (12-1-2017)

    Integrated health management
    • Personal Health Support Services
    • Types of review
    • Pharmacy
    • Quality program

    Integrated health management (12-1-2017)

    Member eligibility and coverage
    • Eligibility and benefits
    • Medical emergency
    • Member appeals, rights, and responsibilities
    • Member copays, co-insurance, and deductible

    Member eligibility and coverage (12-1-2017)

    Plans and service areas
    • Group plans/Individual plans
    • Networks
    • Referral process

    Plans and service areas (12-1-2017)

    UB-04 billing
    • Hospital inpatient notifications
    • Transfer of patients
    • Hospital bill audits
    • Interim bills and late charges
    • Ambulatory surgery centers (ASCs)

    UB-04 billing (12-1-2017)