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Refer to the Hospital Manual page for information about our policies, procedures, and a variety of topics important to facilities.
Hospital Network Consultants are available to answer questions and educate about our hospital network and programs. For additional educational opportunities, view the Hospital Timely Topics Webcasts. Always check Eligibility and Benefits for information on copays, coinsurance, deductibles, referral requirements, medical records, the Patient Health Snapshot and more. View the Eligibility and Benefits Quick Reference Guide for explanations on commonly used terms.
Blue Distinction® Specialty Care
The Blue Distinction Specialty Care Program is a national designation program recognizing healthcare providers who demonstrate expertise in delivering quality specialty care safely, effectively and cost-efficiently.
Hospital Choice Network
The Hospital Choice Network (HCN) is a collaborative effort to ensure fiscal responsibility, high-quality outcomes and patient satisfaction in network hospitals. To measure the success of these goals, hospitals are evaluated in three categories: Cost, Quality and Patient Experience. Based on the scores hospitals receive in these three categories, hospitals are ranked as Lower or Higher Cost Share facilities.
Hospital Quality Programs
Our adverse events policy is an effort to improve the quality of patient care by reducing or eliminating the occurrence of "never events" and certain hospital-acquired conditions. View our Adverse Events page for a list of adverse events and FAQs.
Alabama Hospital Quality Initiative (AHQI)
AHQI is a partnership between Alabama hospitals, CareFusion MedMined™, The Alabama Hospital Association, and Blue Cross and Blue Shield of Alabama to help fight healthcare-associated infections.
Inpatient Concurrent Utilization Review Program (CURP)
The goal of CURP is to ensure appropriate and efficient use of hospital services while maintaining high-quality patient care. The CURP review process and Jiva Provider Portal entry include InterQual Criteria pertinent to inpatient general medical and surgical episodes of care. Reviews are conducted the first business day following hospital admission. Continued stay reviews occur cyclically through the hospital stay based on clinical condition and criteria.
Facility Urgent Care Program
The Facility Urgent Care Program provides a new option for non-emergent care at hospitals. It provides a win-win solution for hospitals and patients, especially in rural areas where patients often travel long distances to get the care they need.
View our Know Where to Go brochure for information to share with your patients regarding where to go for the most appropriate care, i.e., a primary care physician, urgent care facility or emergency room.
Outpatient Enhanced Ambulatory Patient Grouping (EAPG) Program
The Enhanced Ambulatory Patient Grouping (EAPG) System by 3M™ is a patient classification system designed to reflect the amount and type of resources used in an outpatient visit through the use of one set of payment weights that reflect the relativity of costs for all services in the payment system.
Ambulatory Surgical Center Medicare Advantage Reimbursement
Medicare Advantage reimbursement for ambulatory surgical centers is 100% of the CMS
Sleep Disorder Testing
The Blue Cross and Blue Shield of Alabama Preferred Sleep Medicine Program, effective December 1, 2016, supports the Medical Policy #305, Polysomnography for Respiratory Sleep Disorders Testing.