The Provider Handbook is designed to provide details about doing business with BCBSVT including, plan policies, procedures and requirements.
Other types of reference guides:
(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.
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.
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: BCBSVT contracted hospitals with laboratory services are also eligible to render services. The BCBSVT 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|
BCBSVT members have access to certain mental health and substance abuse services for the same co-payment as their primary care provider visit. 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 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.
|Prevent Hospital Readmission|
A provider/patient tool of tips to reduce the changes 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.
How to create an account, maintain users and use the eligibility, claim look-up, Clear Claim Connect and online prior approval functionality.
List of benefits requiring prior approval.
Comprehensive reference and requirements for providers.
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.
|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.
|CMS 1500 Form Instructions|
BCBSVT information on completing the CMS 1500 form.
|CMS 1500 Form SAMPLE|
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.