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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

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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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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.