See Our BlueCard^® Program Checklist for Out‑of‑Area Member Claims

As part of our BlueCard program, you may see members with Blue Cross and Blue Shield Plans from other states. Review our checklist for filing out‑of‑area member claims.

Take Note of Prior Authorization Changes for Commercial and Government Plans

Effective Oct. 1, 2025, prior authorization requirements for certain commercial and government plans are changing to reflect new, replaced or removed codes.

Encourage Pediatric Well‑Child Visits and Immunizations

We track quality measures to help close gaps in our members’ care. Review tips for documenting visits and vaccines.

Review New Clinical Practice Guideline on Hepatitis C

We adopted a guideline on testing, managing and treating hepatitis C virus from the American Association for the Study of Liver Diseases and Infectious Diseases Society of America. Learn about the recommendations.

See Resource on ICD‑10 Z Codes to Help Track Members’ Social Needs

We encourage adding ICD‑10‑CM Z codes on claims to document social determinants of health that may affect our members. Refer to our flyer for sample codes.

Explore Learning Opportunities

We offer free training for providers who participate in our networks. Review and sign up for sessions, including courses on Availity^® Essentials tools.

Provide Records to Support Risk Adjustment Data Validation Audit

You may receive medical record requests for the Centers for Medicare & Medicaid Services’ RADV audit. If you receive a letter from us and our vendor, please respond as soon as possible.

Verify Your Directory Information Every 90 Days

Our members rely on our provider directory for accurate information about your practice. Review and verify your data every 90 days and update it when it changes.

Review Reminder on Billing Point‑of‑Use Convenience Kits

These prepackaged kits include supply items in addition to injectable medicine. We reimburse only the drug component of the kits.

Pharmacy Program Quarterly Update — Part 2

Changes were made to our drug lists and utilization management program. Learn about these and other pharmacy program updates.

Learn About Updates to Clinical Payment and Coding Policies

We regularly add and modify CPCPs as part of our ongoing policy review. See which policies were updated and when.

Review Medical Policy Updates

Approved new or revised medical policies and their effective dates are usually posted on our website the first and 15th of each month. You can view all active and pending policies, as well as draft medical policies, and provide comments on draft policies. These policies may impact your reimbursement and your patients’ benefits.