Resources

As a practitioner, you have the right to request a copy of the criteria used in the utilization management (UM) decision-making for your patients. Blue Cross’ medical policies are available online at AlabamaBlue.com/Providers/Policies. FEP medical policies are available online at www.fepblue.org.

Blue Cross uses nationally recognized, evidence-based criteria, claims data and medical policies in UM reviews. To review criteria used in an adverse benefit decision, email a Provider Networks Consultant at Ask-PSC@bcbsal.org to schedule an appointment with a Blue Cross subject matter expert. The Provider Networks Consultant will contact Health Management with the physician contact information so an appointment may be scheduled. For acute inpatient level of care, contact the Clinical Auditor assigned to the nearest in-network facility. 

If you have questions about UM, contact Provider Customer Service at 1-877-231-7239.