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Manuals and Guides
2024 Blue Advantage FAQs
2023 Blue Advantage Provider Administrative Manual
2023 Blue Advantage Provider Quick Reference Guide
2024 Blue Advantage Provider Administrative Manual
2024 Blue Advantage Provider Quick Reference Guide
2025 Blue Advantage Provider Administrative Manual
2025 Blue Advantage Provider Quick Reference Guide
Blue Advantage Provider Portal User Guide
Newsletters
Webinars and Workshops
DSNP Annual Training
December 2024 New to Blue Advantage Webinar
November 2024 BA Behavioral Health Webinar
July 2024 Blue Advantage PCP Incentive Coupon Webinar
December 2023 BA Provider Workshop
December 2020 Blue Advantage Portal Webinar
July 2020 Risk Adjustment Webinar
February 2019 BA Utilization Management Strategy Webinar
New/Revised Medicare Advantage Medical Policies
The Medicare Advantage (MA) Plan must follow all traditional Medicare NCDs and LCDs applicable to the MA Plan’s service area per 42 CFR § 422.101. When coverage criteria are not fully established in traditional Medicare statutes, regulations, NCDs or LCDs (applicable to the MA Plan’s service area), internal coverage criteria can be developed. Internal coverage criteria may be similar or the same as criteria found in LCDs that are applicable outside the MA Plan’s service area, as long as, the criteria are based on current evidence in widely used treatment guidelines or clinical literature and is made publicly available.
The Blue Advantage medical policies below offer clinical guidelines for healthcare providers. These policies are a summary of evidence, list of resources and an explanation of the rationale that supports the adoption of the coverage criteria and are used unless Federal law takes precedence over the policy.
In addition, Blue Advantage uses InterQual criteria, which can be accessed (by providers and members) through the InterQual® Transparency Tool. Registration is required to access the InterQual tool.
Please verify member benefits, limitations and exclusions of coverage before services are rendered.
Current Policies
New Policies Effective Jan. 1, 2025
New Policies Effective Feb. 1, 2025
New Policies Effective March 1, 2025
Revised Policies Effective Jan. 1, 2025
HMO Louisiana, Inc. offers Blue Advantage (HMO). Blue Cross and Blue Shield of Louisiana offers Blue Advantage (PPO). Both are independent licensees of the Blue Cross and Blue Shield Association.
Blue Advantage from HMO Louisiana, Inc. is an HMO plan with a Medicare contract. Blue Advantage from Blue Cross and Blue Shield of Louisiana is a PPO plan with a Medicare contract. Enrollment in either Blue Advantage plan depends on contract renewal.
For full Blue adVantage online provider services, such as claim status checks, member eligibility, benefit verification or confirmation of prior authorization, use our Blue adVantage Provider Portal. Visit iLinkBlue, then click on “Blue Advantage” under the “Other Sites”
