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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 
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. 
Recognizing and reporting Fraud, Waste, and Abuse 
How to use our provider website to determine whether a service requires precertification and to submit the following requests for members 
Understanding Dual Eligible Medicare Advantage Plans 
Frequently Asked Questions 
Information and frequently asked questions about plans for members eligible for both Medicare and Medicaid. 
Some services are excluded by CMS by statute, the above FAQ will help answer your questions on how this pertains to Medicare Advantage.  
Information and frequently asked questions billing for members of DSNP plans 
Information and frequently asked questions on OptiNet, an online imaging provider registration tool administered by AIM Specialty Health®. 
Information and frequently asked questions on the January 1, 2016 DME contract update and the standardization of fee schedules.  
Blue Cross and Blue Shield of Georgia moved Individual (non-group) Medicare Advantage members to a single claims processing system Jan. 1, 2015.  
Where to file an appeal, time frames, who can file, MAXIMUS, and more.  
Where to file, what additional fields are required on the claims, and how to check the status of claims 
 
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