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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 Forms

PW_E194977

Precertification* 
Beneficiary Notice Forms  
 
Medicare Part D Rx Coverage Determinations and Appeals 
Providers can send a request for a prescription coverage determination or an appeal for a Medicare plan via email rather than fax or phone by sending the request to the following address: medicarepartdparequests@express-scripts.com  
General Correspondence  
General Correspondence Form
To be used for Corrected Claims, Coverage Verification, Explanation of Benefits, Prior Authorization 

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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.