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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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New Non-Par Provider Load

If a non-par provider wishes to see BCBSGa members, they must be loaded in our system. Please follow the below steps to ensure you are loaded. 
1. The Provider must submit a request on their office letterhead. 
2. The letter must specifically state the purpose of the request is to have the provider added as a non-participating/ Out of network provider. 
3. The request must accompany a completed W-9 
4. The request must include ALL data elements listed below.  
Purpose: add provider as a non-participating/ Out of network provider
Effective date:
Provider’s Full Name:
Provider Specialty:
Providers Ga State License Number:
Individual Provider’s NPI:
Practice Tax ID:
Practice/ Group NPI:
Provider’s Practice Address(es)
Provider’s Billing/ Remittance Address
Provider’s Contact Name
Provider’s Contact Phone Number
Provider’s Contact Person’s Email Address
Please specify whether you submit claims using a facility UB-04 or a professional CMS 1500 form
The provider should fax the request to 706-985-0053. The provider can follow-up on the submitted request in 30 days by contacting Customer Service at the phone number listed on the back of the member’s ID card.  
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