Provider Handbook & Reference Guides

Provider Handbook

The Provider Handbook is designed to provide details about doing business with Blue Cross and Blue Shield of Vermont including, plan policies, procedures, and requirements.

Other types of reference guides:


General

DocumentDescription

Accordant - Rare Condition Program

(Blue Cross and Blue Shield of Vermont partners with Accordant Health Services)

Blue Cross and Blue Shield of Vermont Rare Condition Program that helps your patients improve their condition, enhance their knowledge and self-management skills, and achieve your therapeutic goals for them.

Blood Pressure Monitoring (patient self-measured)

Information that is part of the Blood Pressure Program developed by the AMA. Designed to help you and your office staff engage your patients in the self-measurement of their own blood pressure.

Community Preventive Services Task Force Findings on self-measured BPM

Claims Submission Guidelines for Providers With More than One Blue Plan Contract:

 
Communication Form for Behavioral Health and
Primary Care Providers

Use this template to facilitate the communication between behavioral health and primary care providers to assist in patient care coordination for patients receiving mental health or substance abuse services.

Note:  the patient should consent to the sharing of the information.

Corrected Claim Submission Guidelines

Instructions for faxing or emailing of 'corrected claims.'

Durable Medical Equipment Claim Submission Flow Chart for BlueCard®

A flowchart to determine which Plan to submit DME BlueCard claims.

Independent Laboratory List

Lab Draw Stations

Providers must use/refer members to in-network laboratories. The lists provide the details for contracted independent laboratory and lab draw stations.

Note: Blue Cross and Blue Shield of Vermont contracted hospitals with laboratory services are also eligible to render services. The Blue Cross and Blue Shield of Vermont contracted hospital can be found on the Find-a-Doctor link.

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

Link to terms of Medicare Advantage payments.

Mental Health and Substance Abuse Co-Payments

Blue Cross and Blue Shield of Vermont members have access to certain mental health and substance abuse services for the same co-payment as their primary care provider visits. This links to the services that are eligible.

Pediatric Patient Transition Template

Letter template that can be used to notify adult pediatric patients of the need to transition to an adult practitioner.

Prefix Listing 

Prefixes for Blue Cross and Blue Shield of Vermont, 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.

Prevent Hospital Readmission

A provider/patient tool of tips to reduce the chances of an unplanned readmission.

Preventive Care Benefits for Members

List of preventive health services defined within the Affordable Care Act that do not have member liability.

Provider Resource Center Reference Guide

How to create an account, maintain users and use the eligibility, claim look-up, Clear Claim Connect and online prior approval functionality.

Prior Approval

List of benefits requiring prior approval.

Provider Handbook

Comprehensive reference and requirements for providers.

Unit Designation

Spreadsheet (in excel format) with two tabs; one tab for those codes with a single unit designation and a second tab for those codes with a multiple unit designation. This spreadsheet is updated quarterly and re-posted.

Vision Service Overview for Federally Qualified Health Plans

Summary of vision benefits for Members who have Federally Qualified Health Plans.


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Institutional/Facility

DocumentDescription
Census Reporting for Facilities 
Census Reporting Template 
Emergency Room 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.


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Professional

Document Description
CMS 1500 Form Instructions 

Blue Cross and Blue Shield of Vermont information on completing the CMS 1500 form.

CMS 1500 Form SAMPLE

Sample form

 


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New Provider Orientation

DocumentDescription

Mental Health and Substance Use Disorder Clinicians 

All other provider types (MD, DO, ND, PA, NP, etc) 

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.

 


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