Resources

We continually update as well as develop educational documents to assist our network providers with their Blue Cross needs.

Plus sign that becomes an "X" when the accordion collapses to show more content Forms

Admissions and Recertifications Form
Alternative Dental Procedure Payment Responsibility Form
Authorization Form
Behavioral Health Provider Clinical Profile Form
Claims Dispute Form
Consumer's Right to Know Facility Reporting Form
Continuity of Care Request Form
Coordination of Benefits Questionnaire
Electronic Funds Transfer Application
Electronic Funds Transfer Termination or Change Form
Electronic Remittance Advice (ERA) Enrollment Form
Health Delivery Organization (HDO) Form
Health Delivery Organization (HDO) Reverification Form

How to Request Act 897 Provisions
iLinkBlue Agreement Packet
Itemized Bill Cover Sheet
Louisiana Standardized Credentialing Application
Recredentialing Application
Overpayment Notification Form
Professional Liability Information Form
Provider Update Form

Release of Protected Health Information Form
Request for Taxpayer Identification Number and Certification
Utilization Management Approval and Denial Fax Form

Plus sign that becomes an "X" when the accordion collapses to show more content New/Revised Medical Policies

Effective Jan. 1, 2019
Policy No. 00005 Augmentative and Alternative Communication Devices
Policy No. 00141 Risk-Reducing Mastectomy
Policy No. 00223 golimumab (Simponi Aria®, Simponi®)
Policy No. 00324 GLP-1 Agonists for Diabetes
Policy No. 00338 Beta Adrenergic Antagonists and Beta Adrenergic Antagonist/Diuretic Combination Drugs
Policy No. 00343 Topical Acne Products
Policy No. 00363 Select Ophthalmic Prostaglandins
Policy No. 00385 Sodium-Glucose Co-Transporter-2 (SGLT-2) Inhibitors and Combination Products
Policy No. 00564 Select Dexamethasone Packs
Policy No. 00581 Topical Antipruritics
Policy No. 00625 Select Drug Quantity Management
Policy No. 00626 Pheochromocytoma Medications (Demser®, Dibenzyline®, generics)
Policy No. 00627 eltrombopag (Promacta®)
Policy No. 00628 dextromethorphan/quinidine (Nuedexta®)
Policy No. 00629 parathyroid hormone (Natpara®)
Policy No. 00630 Ethacrynic Acid Oral Products (Edecrin®, generics)
Policy No. 00631 Sensipar® (cinacalcet)
Policy No. 00632 Urea Cycle Disorder Pharmacologic Agents (Buphenyl®, Ravicti®, generics)
Policy No. 00636 methergine/methylergonovine tablets
Policy No. 00639 Saturation Biopsy for Diagnosis, Staging, and Management of Prostate Cancer
Policy No. 00640 Restasis® (cyclosporine ophthalmic)
Policy No. 00641 Pharmacotherapy for Gaucher Disease
Policy No. 00642 Select Oral Oncology Drugs

Effective Nov. 1, 2018
Policy No. 00016 Closure Devices for Patent Foramen Ovale and Atrial Septal Defects
Policy No. 00391 Tumor Treating Fields Therapy
Policy No. 00441 Fecal Microbiota Transplantation
Policy No. 00624 Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)