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, go to|
|Health management programs
Resources about case management, care management for chronic conditions, and referrals.
|Health Management Programs|
We use Change Healthcare’s criteria as well as supplemental guidelines to determine medical necessity.
|InterQual® Criteria & SmartSheets
Coverage Criteria & Guidelines (for certain services that are not addressed by InterQual criteria or medical policies)
Medical policies will help you to determine what we cover and why.
|Member rights and responsibilities
Information about access-to-care and member rights and responsibilities.
|See Member Rights and Responsibilities by logging in and going to Office Resources>Policies & Guidelines> Provider Manuals.
As part of our compliance with NCQA, we want providers to understand our standards for utilization management.