Blue Cross Blue Shield Vermont
    Provider Forms

Administrative Forms
Coordination of Benefits Questionnaire

Chiropractic Plan of Treatment    (Instructions)

Provider Overpayment Form

Claim Editing Appeal Request Form

HCFA 1500

CMS 1500 Billing Instructions

Inpatient Pre-certification Request Form

New England Health Plan (NEHP) Medical Services requiring Referral Authorization

Payment Inquiry Form

Prior Approval Request Form for Medical Procedures - Interactive PDF

Prior Approval Request Form for DME, Orthotics and Prosthetics

(Instructions)

UB 04 Billing Instructions

Operational Training Sessions
2007 Fall Training Session - Bennington Q & A

2007 Fall Training Session - Brattleboro Q & A

2007 Fall Training Session - Montpelier Q & A

2007 Fall Training Session - Newport Q & A

2007 Fall Training Session - Rutland Q & A

2007 Fall Training Session (C. Smith Presentation) - So Burlington Q & A

2007 Fall Training Session (Fletcher Allen Health Care) - So Burlington Q & A

2007 Fall Training Session - (W.York Presentation) So. Burlington Q &A

2007 Fall Training Session - Springfield Q & A

2007 Fall Training Session - St. Johnsbury Q & A

2007 Fall Training Session - St. Albans Q & A

2007 Operational Training Session

2006 Operational Training Session FAQ

Provider Enrollment and Credentialing
Blue Cross and Blue Shield of Vermont will accept a printed copy of the CAQH credentialing application accompanied by the Statement of Verification and Release Form.
NPI Submission Form

Provider Enrollment Change Form

W9

Practitioner Credentialing Rights

CAQH Application for Credentialing

Reference Guides
Adult Preventive Guidelines

Surgical Assistant List

Clinical Practice Guidelines

Chiropractic Plan of Treatment Instructions

2008 Prior Approval - Medical Services Comprehensive Procedure and CPT Code Listing

2008 Prior Approval - DME, Orthotics, and Prosthetics Comprehensive Procedure and CPT Code Listing

Provider Manual (2.8 MB PDF)

Medicare Advantage Private Fee-for-Service
(PFFS) Terms & Conditions Web Finder Tool

Institutional Billing of Late Charges

**Note: Surgical Assist and Pre-Op and Post-Op lists are dated 4/06, but are valid through 2007

Pre-Op & Post-Op Lists

  Pre-Op Day 0 Post-Op Day 10

Pre-Op Day 0 Post-Op day 45

Pre-Op Day 1 Post-Op Day 1

Pre-Op Day 1 Post-Op Day 90

Pre-Op Day 270 Post-Op Day 45

**Note: Surgical Assist and Pre-Op and Post-Op lists are dated 4/06, but are valid through 2007

BlueCard Advisories
2008
2008 March

2007
2007 December

2007 September

2007 June

2007 March
 
2006
2006 December

2006 September

2006 June

2006 March

2005
2005 December

2005 September

2005 June

2005 March

EDI

  NPI Testing Requirements

EDI Enrollment Form    (updated 4/16/08 --  interactive PDF)

835 Companion Guide

837 Professional Companion Guide (6 MB)

837 Institutional Companion Guide (4 MB)

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Blue Cross Blue Shield Vermont