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Provider Manual & Reference Guides
Comprehensive details regarding plan policies and procedures.
Other types of reference guides:
|Accordant - Rare Condition Program
(BCBSVT partners with Accordant Health Services)
|BCBSVT Rare Condition Program that helps your patients improve their condition, enhance their knowledge and self-management skills, and achieve your therapeutic goals for them.|
|Breast Pump (how to determine eligibility)||Eligibility and coding details for breast pump benefits.|
|Claims Requiring Paper Submission||Claims that require paper submission.|
Claims Submission Guidelines for Providers With More than One Blue Plan Contract:
|Corrected Claim Submission Guidelines||Instructions for mailing, faxing or emailing of 'corrected claims.'|
|Essential Health Benefits||List of services that are part of the Essential Health Benefits covered under federally qualified health plans offer through the Vermont Exchange.|
|Federal Preventive Grid (for Members)||List of preventive health services defined within the Affordable Care Act that do not have member liability.|
|Medicare Advantage Claim Requirements|
|Medicare Advantage Private Fee-for-Service (PFFS) Terms and Conditions Web Finder Tool||Link to terms of Medicare Advantage payments.|
|Pediatric Patient Transition Template||Letter template that can be used to notify adult pediatric patients of the need to transition to an adult practitioner.|
Prefixes for BCBSVT, CBA and New England Health Plan (NEHP)
All Federal Employee Program members begin with an 'R'
|Prescription Drug Formulary||Understand medication choices and make informed decisions.|
|Prior Approval||List of benefits requiring prior approval.|
|Product Overview - BCBSVT, CBA Blue, TVHP, and NEHP||A high-level overview of each plan product, including exchange products.|
|Provider Manual||Comprehensive reference and requirements manual for providers.|
|Unit Designation||List of procedure codes where changes in their unit designation have occurred.|
|Vision Service Overviews:Healthcare Exchange Members||Summary of vision benefits for Healthcare Exchange.|
|Census Reporting for Facilities
Census Reporting Template
|Overview of the requirements and process for Census reporting.|
|Late Charges - Institutional Submission Requirements||How to submit late charges once the original claim has been processed.|
|Outpatient Revenue Codes Requiring a CPT or HCPCS||List of Revenue codes requiring a CPT or HCPCS code for outpatient services.|
|UB-04 Paper Claim Billing Instructions||Instructions for completing the paper UB-04 Facility/Institutional claim form.|
Instructions on completing CMS 1500 forms - accepting old form (version 08/05) until 10/01/15.
|CMS 1500: Form 0938-1197||Instructions on completing CMS 1500.|
This information is designed for newly contracted providers. It provides an overview of how to do business with Blue Cross and Blue Shield of Vermont.