Blue Cross and Blue Shield of Alabama contracted with the Centers for Medicare & Medicaid Services (CMS) to provide Medicare covered services to beneficiaries through a Medicare Advantage Plan. Our Blue Advantage plan is a Medicare-approved Preferred Provider Organization (PPO) Plan option for beneficiaries living in the state of Alabama. Blue Advantage provides the same level of benefits that a beneficiary would be entitled to if covered by Medicare.
View our Blue Advantage Provider Manual and Blue Advantage Participating Provider Agreement for more information about your responsibilities as a Blue Advantage Network provider.
Readmission Review Program
Effective January 1, 2020, we adopted a 30-day Readmission Review Policy for Blue Advantage members. We will review all readmissions to the same facility within 30 days of discharge. If a readmission is determined to be inappropriate or preventable, the stay will be considered part of the initial admission. View our Readmission Review Program FAQs for more information.
Patient Health Programs and Resources
Behavioral Health Toolkit
A toolkit is available to provide you with assessment and intervention tools that can be helpful when providing care to patients who may have behavioral health needs.
Fall Prevention
According to the CDC, each year millions of people 65 and older fall. Here are ways to help elderly patients reduce the risk of falling.
Osteoporosis Management
With appropriate screening and treatment, you can reduce the risk of future osteoporosis-related fractures for your patients.
Osteoporosis Management In Women Who Had a Fracture (OMW)
This HEDIS measure assesses women 67-85 years of age who suffered a fracture and who had either a bone mineral density test or a prescription for a drug to treat osteoporosis in the six months after the fracture.
Patient Handouts Request Form
Order patient handouts free of charge.
Reporting a Medically Necessary E/M Code with an Annual Wellness Visit
There are three Healthcare Common Procedure Coding System (HCPCS) codes available to providers when reporting an Annual Wellness Visit (AWV) exam for Blue Advantage patients.
Acupuncture for Chronic Low Back Pain
Effective for services performed on or after January 21, 2020, CMS allows Medicare patients to receive acupuncture to treat chronic low back pain. This new benefit applies to Blue Advantage® patients. Detailed information about this acupuncture benefit is available on CMS’ website.
Adult Quality Measures Coding Guide
This coding resource will help you close gaps in patient care.
Pre-Service Organization Determination
Providers can obtain a Pre-Service Organization Determination for services. Check Eligibility and Benefits to ensure benefits are provided for services being submitted. A standard and expedited option is available for requests. Please use the appropriate form for the service being requested:
Blue Advantage Medical Risk Reviews
Every year, Blue Cross works to ensure that there is appropriate documentation necessary to clarify specific medical conditions for our Blue Advantage members. Your help with this effort is appreciated as we work to meet CMS requirements and standards.
Fraud and Abuse
You can remain anonymous when reporting healthcare fraud and abuse. To report possible healthcare fraud and abuse, use one of the following contact methods:
CMS’ website offers numerous resources, including fraud prevention training materials, that can be found using the search term “fraud.” Additionally, our Fraud and Abuse webpage includes educational information that can educate providers and patients.
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