PA Resources Portlet

Resources

CODING & DOCUMENTATION

EDUCATION & EVENTS

ENROLLMENT & CREDENTIALING

FORMS & MANUALS

PATIENT HEALTH

PHARMACY

POLICIES & GUIDELINES

Advanced Imaging

Autism Spectrum Mandate

Behavioral Health

Blue Advantage Policies

Chronic Condition Management

Clinical Practice Guidelines

COVID-19

HealthSmartRx Smart RxAssist

Hemophilia Drug Management

Medical Nutrition Therapy Services

Medical Policies

Medical Records Requests

No Surprise Billing Act

Operational Guidelines

Provider Appeals

Provider Disputes

Provider-Administered Drug Policies (Excluding Oncology)

Provider-Administered Oncology Drug Policies

Radiation Therapy Management (RTM)

Self-Administered Drug Policies

Subrogation

Telehealth and Remote Access Telemedicine

Transgender Services

PRE-SERVICE REVIEW

PROGRAMS & INITIATIVES

PROVIDER eSOLUTIONS

PROVIDER NETWORKS & SPECIALTIES

PA Dynamic Rendering

Provider Appeals

Provider Appeals

Blue Cross and Blue Shield of Alabama has an established appeals process for providers and physicians. The following documentation provides guidance regarding the process for appeals. Three forms are also available to aid providers in preparing an appeal request. Please make sure you select the appropriate form to address your specific need.

For more information about the appeals process, see the following:

Providers are required to file all post-service appeals to their local Blue Cross Plan regardless of the member's Home Plan. For example, if an Alabama physician provides services to a member with Blue Cross and Blue Shield of Kansas coverage and a post-service appeal is needed, the physician should fill out the appropriate form from above and submit it to Blue Cross and Blue Shield of Alabama.

Please attach any additional information and/or medical records at the time of filing the appeal for consideration.

Preservice and concurrent appeals should continue to be submitted to the member's Home Plan.