Professional Provider Manuals

Professional Provider Manual

• Competitive Allowance Program
• Policy Memos
• How to Complete a CMS 1500 Claim Form
• Procedure Code Listings
  • Assistant Surgery Not Medically Necessary Listing
  • Preventive Services Quick Reference Guide
• Physician Fee Schedule Database Indicators (offsite link)
  • Medicare's Medically Unlikely Edits (offsite link)
• BlueCard
• Other Party Liability
• Remittance Advice
• Communicating with BCBSKS
• 2021 HEDIS Coding & Reference Guide
• 2022 HEDIS Coding & Reference Guide
• 2023 HEDIS Coding & Reference Guide
• 2023 HEDIS Coding & Reference Guide (Value-Based)
• 2024 HEDIS Coding & Reference Guide (QBRP + PCMH)
• 2025 HEDIS Coding & Reference Guide
• Specialty Guidelines
  • Ambulance
  • Autism
  • Behavioral Health
    • IOP-PHP Addresses and Programming
    • Lucet Health 2024 Medical Necessity Criteria (offsite link)
  • Durable Medical Equipment/Home Medical equipment (DME/HME)
  • Health Department Billing Guidelines
  • Home Infusion Therapy
  • Physical Medicine
    • Chiropractic FAQs
  • Substance Abuse
  • Vision & Ocular