Medical Reference Manuals

• Contact information - plans and departments
• Service teams - where to obtain assistance
• Confidentiality policy
• Appointment access standards for providers

Contact information, confidentiality, and appointment access (2-2023)

• Types of service covered
• Claims and billing
• Home based services - home health and hospice, medical equipment, infusion
• Prosthetics/Orthotics
• Alternative Care Services

Ancillary (3-2022)

• BlueCard^® Program
• Shared Administration

BlueCard and Shared Administration (9-2022)

• Submitting claims
• CMS 1500 completion
• Reimbursement
• Explanation of Payment
• Statement of Overpayment Recoveries

Claims submission and payments (4-2022)

• Coding types and sources
• Special billing situations
• Most commonly used modifiers
• NDC code billing guidelines

Coding and billing guidelines (4-2022)

• Credentialing process
• Contracting process
• Terminating a contract
• Credentialing and claims
• Confidentiality
• Information/address changes

Credentialing and contracting (2-1-2021)

• FEP ID cards

ID cards (1-1-2024)

• Personal Health Support Services
• Types of review
• Pharmacy
• Quality program

Integrated health management (9-2022)

• Eligibility and benefits
• Medical emergency
• Member appeals, rights, and responsibilities
• Member copays, co-insurance, and deductible

Member eligibility and coverage (11-1-2018)

• Group plans/Individual plans
• Networks
• Referral process

Plans, service areas, networks (1-1-2024)

• Hospital inpatient notifications
• Transfer of patients
• Hospital bill audits
• Interim bills and late charges
• Ambulatory surgery centers (ASCs)

UB-04 billing (7-2022)