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Provider Manual & Reference Guides
Comprehensive details regarding plan policies and procedures.
Other types of reference guides:
|Accordant - Rare Condition Program
(BCBSVT partners with Accordant Health Services)
|BCBSVT Rare Condition Program that helps your patients improve their condition, enhance their knowledge and self-management skills, and achieve your therapeutic goals for them.|
|Breast Pump (how to determine eligibility)||Eligibility and coding details for breast pump benefits.|
Blood Pressure Monitoring (patient self-measured)
Information that is part of the Blood Pressure Program developed by the AMA. Designed to help you and your office staff engage your patients in the self-measurement of their own blood pressure.
|Claims Requiring Paper Submission||Claims that require paper submission.|
Claims Submission Guidelines for Providers With More than One Blue Plan Contract:
|Communication Form for Behavioral Health and
Primary Care Providers
Use this template to facilitate the communication between behavioral health and primary care providers to assist in patient care coordination for patients receiving mental health or substance abuse services.
Note: the patient should consent to the sharing of the information.
|Corrected Claim Submission Guidelines||Instructions for mailing, faxing or emailing of 'corrected claims.'|
|Essential Health Benefits||List of services that are part of the Essential Health Benefits covered under federally qualified health plans offer through the Vermont Exchange.|
|Federal Preventive Grid (for Members)||List of preventive health services defined within the Affordable Care Act that do not have member liability.|
|Medicare Advantage Claim Requirements|
|Medicare Advantage Private Fee-for-Service (PFFS) Terms and Conditions Web Finder Tool||Link to terms of Medicare Advantage payments.|
|Mental Health and Substance Abuse Co-Payments||BCBSVT members have access to certain mental health and substance abuse services for the same co-payment as their primary care provider visit. This links to the services that are eligible.|
|Pediatric Patient Transition Template||Letter template that can be used to notify adult pediatric patients of the need to transition to an adult practitioner.|
Prefixes for BCBSVT, CBA and New England Health Plan (NEHP)
All Federal Employee Program members begin with an 'R'
|Prescription Drug Formulary||Understand medication choices and make informed decisions.|
|Provider Resource Center Reference Guide||How to create an account, maintain users and use the eligibility, claim look-up, Clear Claim Connect and online prior approval functionality.|
|Prior Approval||List of benefits requiring prior approval.|
|Product Overview - BCBSVT, CBA Blue, TVHP, and NEHP||A high-level overview of each plan product, including exchange products.|
|Provider Manual||Comprehensive reference and requirements manual for providers.|
|Unit Designation||List of procedure codes where changes in their unit designation have occurred.|
|Vision Service Overviews:Healthcare Exchange Members||Summary of vision benefits for Healthcare Exchange.|
|Census Reporting for Facilities
Census Reporting Template
Emergency Room Census Reporting Template
|Overview of the requirements and process for Census reporting.|
|Late Charges - Institutional Submission Requirements||How to submit late charges once the original claim has been processed.|
|Outpatient Revenue Codes Requiring a CPT or HCPCS||List of Revenue codes requiring a CPT or HCPCS code for outpatient services.|
|UB-04 Paper Claim Billing Instructions||Instructions for completing the paper UB-04 Facility/Institutional claim form.|
|CMS 1500 Form Instructions||BCBSVT information on completing the CMS 1500 form.|
|CMS 1500 Form SAMPLE||Sample form|
This information is designed for newly contracted providers. It provides an overview of how to do business with Blue Cross and Blue Shield of Vermont.