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

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Georgia Balanced Funding Plans (effective 5/1/2014)

PW_E215704
 

GBF OAH5 1.5K 80 A 
GBF OAH5 2.5K 80 B 
GBF OAH5 500 90 B 
GBF OAP12 2.5K 70 
GBF OAP5 1.5K 80 A 
GBF OAP5 1.5K 80 B 
GBF OAP5 1.5K 90 A 
GBF OAP5 1K 80 A 
GBF OAP5 1K 80 B 
GBF OAP5 1K 90 A 
GBF OAP5 2.5K 100 A  
GBF OAP5 2.5K 100 A  
GBF OAP5 2.5K 100 B  
GBF OAP5 2.5K 80 A  
GBF OAP5 2.5K 80 B 
GBF OAP5 3.5K 100 A  
GBF OAP5 3.5K 70 B 
GBF OAP 5 3.5K 80 A  
GBF OAP 5 3.5K 70 A 
GBF OAP5 500 100 A 
GBF OAP5 500 80 A 
GBF OAP5 500 90 A 
 
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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.