PA Resources Portlet

Resources

CODING & DOCUMENTATION

EDUCATION & EVENTS

ENROLLMENT & CREDENTIALING

FORMS & MANUALS

PATIENT HEALTH

PHARMACY

POLICIES & GUIDELINES

PRE-SERVICE REVIEW

PROGRAMS & INITIATIVES

PROVIDER eSOLUTIONS

PROVIDER NETWORKS & SPECIALTIES

Ambulance

Audiology

Bariatric

Blue Advantage

Blue High Performance

Chiropractic

Dental

Dialysis

Durable Medical Equipment

Home Health

Home Infusion

Hospice

Hospital

Licensed Registered Dietitian

Occupational Therapy

Optometry

Personal Choice Network (PCN)

Physical Therapy

Physician Extenders

Podiatry

Preferred Medical Doctor (PMD)

Preferred Medical Laboratory

Preferred Physician Laboratory

Speech-Language Pathology

PA Dynamic Rendering

Preferred Medical Doctor (PMD)

Preferred Medical Doctor (PMD)

The Preferred Medical Doctor (PMD) network is Blue Cross and Blue Shield of Alabama’s physician network, which is open to doctors of medicine (MD) and doctors of osteopathic medicine (DO). A PMD designation indicates that a provider is an in-network provider for Blue Cross and Blue Shield of Alabama members. For more information, view the PMD Agreement and Exhibits.

PMD Advisory Committee

The Preferred Medical Doctor (PMD) Advisory Committee was created to serve as the principal liaison between network physicians and Blue Cross and Blue Shield of Alabama. The Committee is most valuable for its ability to represent the physicians in their district by giving advice and making recommendations to Blue Cross concerning:

  • Medical treatment criteria,
  • Utilization management policies and procedures,
  • The course and direction in general of the PMD Program in relation to professional matters involving the practice of medicine, and
  • Other matters involving professional medical expertise and judgment of quality care issues.

Advisory Committee members are elected by physicians in their district and serve a three-year term.

Advisory Committee Meeting Summaries

Advisory Committee Districts

Single Specialty Surgical Suite

For information about a separate agreement offering enhanced fee schedule reimbursements for specific surgical procedures, visit the Single Specialty Surgical Suite webpage.

Billing for Noncovered Services
As noted in section 4.5 of the Preferred Medical Doctor (PMD) contract, the physician is responsible for notifying the patient of noncovered services or those services not medically necessary for the treatment of his/her condition. Before performing these services, you should obtain the patient’s signature on a written statement of noncovered services. This document should explain to the patient which services they will be responsible for and the amount of the charge.
HIPAA Privacy and Non-Filed Claims
In order to comply with HIPAA regulations, Blue Cross has a policy regarding claims that members do not want to be filed.
PMD Providers in Contiguous Counties/Out-of-State Members
Effective November 10, 2015, Blue Cross and Blue Shield of Alabama updated claims processing rules for providers in contiguous counties to validate whether or not a member lives in Alabama.
Provider Manual
This is a generic manual that provides helpful contact information, valuable resources, claims processing and operational information as well as information regarding preferred care and participating programs. The content of the manual is intended to be general and applicable to providers of all specialties.