Resources

iLink Blue User Guide

Professional Provider Office Manual

The BlueCard^® Program Provider Manual

Dental Network Provider Manual

Behavioral Health

Blue Connect

Blue HPN

Community Blue

Dental Network

Federal Employee Program (FEP)

HMOLA Network

HMOLA Preferred Lab

Office of Group Benefits (OGB)

Precision Blue

Preferred Care PPO Network

Preferred Care PPO Lab

Provider Self-service Guide

Registration Guide for iLinkBlue MFA

Signature Blue

Availability Standards

Medical Record Guidelines for BlueCard

Inpatient/Outpatient Authorization Guide

Medicare Crossover Claims

Identification Card Guide

Automated Benefits & Claim Status (IVR Navigation Guide)

Refund Request Guidelines for BlueCard®

A Guide for Understanding APTC Grace Periods

Submitting a Corrected Claim

HEDIS Follow-up After Hospitalization for Mental Illness

CES Tool Guide

Blue Cross Claims Confirmation Reports

Past Workshops
2023 Professional Workshop

2022 Facility Workshop

Recent Webinars

2023 BlueCard Webinar

2023 New to Blue Webinar - Professional

2023 New to Blue Webinar - Facility

2023 Provider Credentialing and Data Management

2022 Behavioral Health – ABA

2022 Behavioral Health – Facility

2022 Behavioral Health – Professional

2022 New Security Setup Application Webinar

2022 Laboratory Benefit Management Program

2022 BlueCard Webinar

2019 CES Webinar - Facility

2019 CES Webinar - Professional

2018 ABA WebPass Clinical Review Forms Webinar

2018 Provider Self-service Initiative Webinar

Admissions and Recertifications Form
Alternative Dental Procedure Payment Responsibility Form
Authorization Form
Behavioral Health Provider Clinical Profile Form
Blue Cross CAA Consent Submission Form
Consumer's Right to Know Facility Reporting Form
Continuity of Care Request Form
Coordination of Benefits Questionnaire
Electronic Funds Transfer Application
Electronic Remittance Advice (ERA) Enrollment Form
How to Request Reimbursement During Credentialing
Itemized Bill Cover Sheet
No Surprises Act Open Negotiation Notice
OGB Bariatric Surgery Form
Overpayment Notification Form
Professional Liability Information Form
Provider Disputes Form
Rainmaker Application Form
Release of Protected Health Information Form
Retrospective Review Authorization Form
Utilization Management Approval and Denial Fax Form

The documents below are available in DocuSign® format only. As of March 17, the PDF versions of these forms are no longer available. Submitting these forms in the DocuSign format allows the Provider Credentialing & Data Management staff to continue processing your requests as our employees take precautionary measures to prevent the spread of the novel Coronavirus (COVID-19). For details on completing DocuSign forms, view this guide. When submitting DocuSign documents, please do not separately email them to Blue Cross. We automatically receive your submission from the DocuSign application. Double submissions (submitting through DocuSign and also sending an email of the completed form) could delay the processing time for your request.

Your request can take up to 90 days to process once all required information has been received. Providers will remain non-participating in our networks until their credentialing application has been approved by the credentialing committee and an executed contract is in place.

DocuSign Format
iLinkBlue Agreement Packet

Provider Update Request Form

Professional Initial Credentialing Packet
(now includes LCSA Attachment A)

Facility Credentialing Packet
(now includes all HDO Attachments)

Effective June 1, 2023
Policy No. 00090 - Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions

Effective July 1, 2023
Policy No. 00406: Transcatheter Aortic Valve Implantation for Aortic Stenosis

Effective Aug. 1, 2023
Policy No. 00036 -- Enhanced External Counterpulsation (EECP)
Policy No. 00389 -- Whole Exome and Whole Genome Sequencing for Diagnosis of Genetic Disorders
Policy No. 00570 -- Cardiac Rehabilitation in the Outpatient Setting

Revised Policies
Effective for dates of service on and after June 1, 2023

• Policy No. G2174 – Coronavirus Testing in the Outpatient Setting

Effective for dates of service on and after May 1, 2023

• Policy No. G2063 – Testing for Diagnosis of Active of Latent Tuberculosis
• Policy No. G2121 – Laboratory Testing for the Diagnosis of Inflammatory Bowel Disease
• Policy No. M2091 – Transplant Rejection Testing
• Policy No. M2097 – Identification of Microorganisms Using Nucleic Acid Probes
• Policy No. M2141 – Testing of Homocysteine Metabolism-Related Conditions

Effective for dates of service on and after January 1, 2023

• Policy No. F2019 – Flow Cytometry
• Policy No. G2005 – Vitamin D Testing
• Policy No. G2006 – Hemoglobin A1c
• Policy No. G2008 – Prostate Specific Antigen Testing
• Policy No. G2022 – ANA/ENA Testing
• Policy No. G2031 – Allergen Testing
• Policy No. G2035 – Prenatal Screening (Nongenetic)
• Policy No. G2036 – Hepatitis C
• Policy No. G2042 – Pediatric Preventative Screening
• Policy No. G2044 – Helicobacter Pylori Testing
• Policy No. G2045 – Thyroid Disease Testing
• Policy No. G2050 – Cardiovascular Disease Risk Assessment
• Policy No. G2056 – Diagnosis of Idiopathic Environmental Intolerance
• Policy No. G2060 – Fecal Analysis in The Diagnosis of Intestinal Dysbiosis and Fecal Microbiota Transplant Testing
• Policy No. G2098 – Immune Cell Function Assay
• Policy No. G2099 – Intracellular Micronutrient Analysis
• Policy No. G2105 – Immunopharmacologic Monitoring of Therapeutic Serum Antibodies
• Policy No. G2113 – Oral Screen Lesion Identification Systems and Genetic Screening
• Policy No. G2120 – Salivary Hormone Testing
• Policy No. G2124 – Serum Tumor Marker for Malignancies
• Policy No. G2125 – Urinary Tumor Markers for Bladder Cancer
• Policy No. G2127 – Vectra DA Blood Test for Rheumatoid Arthritis
• Policy No. G2130 – ST2 Assay for Chronic Heart Failure
• Policy No. G2132 – Erectile Dysfunction
• Policy No. G2133 – Zika Virus Risk Assessment
• Policy No. G2138 – Evaluation of Dry Eyes
• Policy No. G2143 – Lyme Disease
• Policy No. G2149 – Pathogen Panel Testing
• Policy No. G2150 – Cardiac Biomarkers for Myocardial Infarction
• Policy No. G2153 – Pancreatic Enzyme Testing for Acute Pancreatitis
• Policy No. G2154 – Folate Testing
• Policy No. G2155 – General Inflammation Testing
• Policy No. G2156 – Urine Culture Testing for Bacteria
• Policy No. G2164 – Parathyroid Hormone, Phosphorus, Calcium and Magnesium
• Policy No. G2173 – Gamma-glutamyl Transferase
• Policy No. G2174 – Coronavirus Testing in the Outpatient Setting
• Policy No. M2041 – Venous and Arterial Thrombosis Risk Testing
• Policy No. M2057 – Diagnosis of Vaginitis including Multi-target PCR Testing
• Policy No. M2058 – Genetic Testing for Adolescent Idiopathic Scoliosis
• Policy No. M2068 – Testing for Alpha-1 Antitrypsin Deficiency
• Policy No. M2091 – Transplant Rejection Testing
• Policy No. M2093 – HIV Genotyping and Phenotyping
• Policy No. M2097 – Identification of Microorganisms using Nucleic Acid Probes
• Policy No. M2116 – Plasma HIV-1 and HIV-2 RNA Quantification for HIV Infection
• Policy No. M2172 – Onychomycosis Testing
• Policy No. T2015 – Prescription Medication and Illicit Drug Testing in the Outpatient Setting