Manuals & Guides

Manuals & Guides

Please refer to these helpful guides and manuals.

  • BlueCard Program Manual — This manual provides you with an overview and describes the advantages of the program. It will also help you guide through eligibility verification, precertification and claims filing processes for out-of-area members. 

  • ClaimsXten: Correct Coding Initiative Reference Guide — Learn about our upgrade to ClaimsXten, a robust claim-auditing software designed to ensure health insurance claims are coded properly. Get details about the claim coding rules and the benefits of this upgrade. ClaimsXten is provided by Change Healthcare, an independent company that offers assistance in coding health insurance claims on behalf of BlueChoice HealthPlan. 

  • Cultural Competency — Learn about the importance of cultural competency in the health care setting.

  • Medical Forms Resource Center (MFRC) Guide — This guide details how to use the MFRC online tool, which allows you to submit your precertification requests for some services electronically. The system is fast and easy to use and ensures accuracy. It also cuts down on follow up calls as all the required information is outlined on the form.

  • Member ID Card Guide — This guide provides you with an overview of our various plans, associated networks and the identification cards you may see.

  • Precertification and Referral Guide — Learn how to submit a referral or precertification request through My Insurance ManagerSM and determine which services we can automatically authorize.

  • Preventive Care Guide — This guide provides an outline of the services the Affordable Care Act approves as preventive for non-grandfathered plans.

  • Provider Reconsideration Process — Get instructions about the provider appeal process for medical necessity and billing and coding disputes. Also, learn when it is appropriate for a provider to file a reconsideration. 

  • Provider Office Administrative Manual — Get an overview of our benefit plans and medical management programs. This manual will also help guide you through credentialing, claims filing and reconsideration.

  • Quick Reference Guide — Use this guide to identify the most efficient method to obtain benefit information and get preauthorization for certain services. 

  • What You Need to Know About Anesthesia — This guide gives an overview of anesthesia procedures, modifiers and filing guidelines. 

  • What You Need to Know About Skilled Nursing Facilities — This booklet gives an overview of procedures, authorization requirements and claims filing guidelines for skilled nursing facilities (SNFs).

  • What You Need to Know About Claim Attachments —  This guide provides you with an overview of the claim Aatachment feature in My Insurance ManagerSM. Use the claim attachments feature to attach records or documents to claims that require additional documentation.