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 |
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Health management programs Resources about case management, care management for chronic conditions, and referrals. |
Health Management Programs |
Medical necessity 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)
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Medical policies Medical policies will help you to determine what we cover and why. |
Medical Policies |
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.
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