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Medical Policy, Clinical UM Guidelines, and Pre-Cert Requirements

View requirements for Local Plan and BlueCard Out-of-Area members.

Search our online provider directory when you need a doctor, hospital, or other health care provider.

Medicare Advantage Provider FAQs

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Training 
Medicare Advantage and Part D Training for Providers
Recognizing and reporting Fraud, Waste, and Abuse 
Website Precertification Request Training
How to use our provider website to determine whether a service requires precertification and to submit the following requests for members 
Dual Eligible Special Needs Plan Provider Training
Understanding Dual Eligible Medicare Advantage Plans 
Frequently Asked Questions 
Medicare Advantage System Migration FAQ
Blue Cross and Blue Shield of Georgia moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015.  
Provider Appeals
Where to file an appeal, time frames, who can file, MAXIMUS, and more.  
Lab, DME, and Specialty Pharmacy Blue Claims
Where to file, what additional fields are required on the claims, and how to check the status of claims 
 
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Blue Cross and Blue Shield of Georgia, Inc. and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.