Review the Latest Updates to Our Professional Provider Manual

Posted on 2019-07-24
Updated on 2019-07-24 16:12:56

In an effort to keep you informed of changes and improvements, we have updated our Professional Provider Manual. Updates were made to the following sections:

Administrative Functions: 

  • Updates to the Reimbursement for Limited Licensed Providers section to include detailed billing information for Physician Assistants, Anesthesia Assistants, Assistant Behavior Analysts and Registered Behavior Technicians, along with reimbursement information for Lactation Consultants. 
  • Updates to the Claims Overpayment section include more information about accessing Provider Refund Submission Forms.
  • Additionally, the Expedited or Emergency Appeals process in the Appeals section was updated and information on CAQH ProView was added to the Medical Credentialing section.

Benefit Exclusions and Limitations - BlueChoice Only:

  • Updates to Pharmacy Tiers under Prescription Drugs subsection.
  • In the Radiology/Imaging section, the subsection titled Multiple CT, MRI and MRA Scans, Same Session was removed.

Care Management:

  • Updates to NCQA and Disease Management sections.

Procedure Code Exception Charts:

  • Procedure code 87651 was added to the Specialists and PCPs list, effective 7/1/19.

Policies and Procedures:

  • The Special Services section was updated to include CPT code 99051.

View and download your copy of the updated manual at