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

Operational Guidelines

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
Modifier KX Guidelines for Use of Imaging Studies
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
Surgery-Related Claims Filing Updates