Blue Cross is dedicated to developing and executing quality initiatives in partnership with our providers. We want you to know that the following information is available on our website.
|Programs & guidelines||To learn more, log on and select|
|Health management programs
Resources about case management, chronic condition management, and referrals.
|Clinical Resources>Health Management Programs|
We use Change Healthcare’s criteria as well as supplemental guidelines to determine medical necessity.
|Clinical Resources>Prior Authorization>InterQual Criteria & SmartSheets
Medical policies will help you to determine what we cover and why.
|Office Resources>Policies and Guidelines>Medical Policies|
|Member rights and responsibilities
Information about access-to-care and member rights and responsibilities.
|Office Resources>Policies & Guidelines>Provider Manuals
See Member Rights and Responsibilities and Medicare Advantage Member Policies and Procedures in the appendix
About our utilization management standards
As part of our compliance with NCQA, we want providers to understand our standards for utilization management.