Blue cross medi-cal provider manual

Members work with a primary care provider to achieve specific goals. Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor s directly.

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You can also call the pharmacy at for commercial group and retail plan members , for Medicare Part D members or for Medicare Advantage members. To be used to capture all required key data for pre-authorization. Genetic Testing Provider Interactive Form. To be used when requesting genetic testing.

This form is specifically for providers to request predetermination services for HMK members. Medicare Advantage Preauthorization List. Patient Assessment Validation Evaluation Form.

To be used when requesting lower extremity prosthetic limbs. If predetermination is necessary, complete this form. BlueCross adopts and disseminates specific nationally recognized clinical practice guidelines for use by our network providers.

The guidelines address acute and chronic medical services, and behavioral health services to assist Practitioners in making appropriate health care decisions for specific clinical circumstances. BlueCross attests that the text and format of these compendia have not been altered in any way, and that these resources should not be construed as a legal or required standard of care.

More information can be found in the U. We hope this will be both convenient and helpful to you in caring for your patients. Paper copies of the guidelines are available upon request by calling Web Content Viewer Display content menu Display portlet menu.

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