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

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

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Medicare Advantage Provider FAQs

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Training 
Medical Record Documentation and Coding Tips
A physician’s prescription to success: Medical Record Documentation and Coding Tips. Risk Adjustment relies on proper documentation and coding. To help ensure you are documenting to the highest degree of specificity for appropriate ICD-10 code assignment, click here to find helpful tips and resources such as: ICD-10-CM Provider Training Mini-Series, Speaking ICD-10-CM, Coding Focus , Top Ten ICD-10-CM Tips, and more. 
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 
2016 DSNP FAQs
Information and frequently asked questions about plans for members eligible for both Medicare and Medicaid. 
Dual Advantage Simple Billing Tips
Information and frequently asked questions billing for members of DSNP plans 
AIM OptiNet FAQ
Information and frequently asked questions on OptiNet, an online imaging provider registration tool administered by AIM Specialty Health®. 
DME Amendment FAQs
Information and frequently asked questions on the January 1, 2016 DME contract update and the standardization of fee schedules.  
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.