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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.

Blue Cross and Blue Shield of Georgia Clinician Tools and Resources

This Blue Cross and Blue Shield of Georgia (BCBSGA) website provides up-to-date information, tools and resources for providers.  
BCBSGA Links  
BCBSGA Provider Home –BCBSGA home page especially designed for use by all of our providers. 
BCBSGA Medicare Advantage Provider Home - Landing page for our Medicare Advantage providers. 
Availity - One Stop Shopping’ for Providers to conduct transactions and exchange information with many payers through a common portal.  
Click Here to contact Case Management and Condition Care Management Provider Referrals.  
Frequently Used CPTII Codes - use CPTII codes for Medicare Advantage claims to help ensure timely and accurate payments. 
External Documents 
Click Here to access our library of educational documents for physicians and practitioners.  
We recognize the importance of Beers Criteria for potentially inappropriate medication use in older adults. Consider drug alternatives when appropriate in prescribing high risk medications in older adults.  
High Risk Medications in Older Adults: Drug Alternative(s)
External Links  
Colorectal Cancer Testing
Cancer Prevention Guidelines
Patient Guides
Health Literacy Programs
Health Literacy Programs
Health Literacy Training
Preventing Chronic Disease Newsletter Archive
Health Risk Assessments and Modes of Provisions for Medicare Beneficiaries
Outreach and Education
Go 4 Life Patient Materials
Men’s Health Materials
Women’s Heath Materials

Patient Materials

Health promotion and Disease Prevention
Rand Research on Health Behavior and Lifestyle Change
Quality Indicators – ACOVE 3
Aging and Primary Care
Health Topics
BCBSGA Newsletter  
Georgia Newsletter - Collection of provider newsletters focusing on Georgia 
© 2015 BlueCross BlueShield of Georgia
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.