PA Resources Portlet









Advanced Imaging

Autism Spectrum Mandate

Behavioral Health

Blue Advantage Policies

Chronic Condition Management

Clinical Practice Guidelines


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


Telehealth and Remote Access Telemedicine

Transgender Services





PA Dynamic Rendering

Operational Guidelines

Applied Behavioral Analysis Therapy Benefits For Publix Members

Effective as of January 1, 2019, Applied Behavioral Analysis (ABA) therapy benefits are now available to Publix members. Our ABA therapy program is designed to assist members and families who have children with autism spectrum disorder (ASD).

Our ABA therapy benefits are managed by a dedicated coordinator through the Publix plan’s case management program, which is administered by Companion Benefit Alternatives (CBA).

ABA therapy covers specific services for members with ASD. ABA involves a treatment team made up of a certified technician and a qualified health professional (typically a board- certified behavioral analyst or a board-certified assistant behavioral analyst) to provide behavioral therapy.

Although our ABA therapy program does not include speech, physical or occupational therapy, these benefits are still covered under the Publix medical plan.

Precertification Required

Precertification by CBA is required for ABA services. An initial request for ABA therapy requires a treatment plan, signed and submitted by a licensed physician.

Florida Blue will not provide coverage for ABA therapy services until you receive approval through the preauthorization review process.

For detailed preauthorization requirements, or for more information about ABA therapy benefits, contact the ABA project coordinator at 1-800-868-1032, ext. 25634, or

Co-Surgeons and Team Surgeons

Under certain circumstances the skills of two surgeons (usually with different specialties) may be required in the management of a specific surgical procedure.

Drug Waste Guideline: Provider-Administered* Drugs or Biologicals
Management of Hyperbilirubinemia in Newborns: Follow-Up Visits
Pediatric and Neonatal Critical Care Services and Intensive (Non-Critical) Care Services
PMD Providers in Contiguous Counties/Out-of-State Members

Blue Cross and Blue Shield of Alabama has claims processing rules for providers in contiguous counties to validate whether or not a member lives in Alabama.

Pre-Service Review for Out-of-Area Members
Blue Cross and Blue Shield Plans give providers the ability to access out-of-area member’s Blue Plan provider portals to conduct electronic pre-service review.
Precertification for Inpatient Procedures
Precertification is required for some inpatient surgical procedures that fall outside of the Concurrent Utilization Review Program (CURP) process. The admitting physician is responsible for initiating and obtaining the precertification prior to the patient being admitted to the hospital.
Predeterminations List
We will provide predetermination reviews for the procedures/services listed on this document.
Professional and Technical Components of X-rays
There are a number of diagnostic x-ray procedures that have professional and technical components. Blue Cross and Blue Shield of Alabama requires global billing for services rendered in an in-office setting for diagnostic services.
Seasonal Vaccines
Supplies and Equipment Provided Through the Physician’s Office
Preferred Medical Doctors (PMDs) may provide supplies, such as crutches, splints, braces, boots, etc., and equipment through their office as a convenience to their patients.
Surgery-Related Claims Filing Updates