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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

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 




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Congestive Heart Failure

Chronic Obstructive Pulmonary Disease

Rheumatoid Arthritis

Major Depressive Disorder

Frequently Asked Questions 
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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