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Policies and Guidelines

We know how complicated the health insurance and managed care industry has become. We also understand how that complexity can impact patient care, as well as your bottom line.

That's why we're offering all of our policies and guidelines in one, easy-to-access section. Here you'll find all you need to know about our products, services, claims and reimbursement processes, drug therapy guidelines, and patient safety resources.

We're here to help you. That's our bottom line.

doctor explains drug therapy guidelines to member

Prior Authorization

Commerical and Medicare Advantage members may require prior authorization (preauthorization) to recieve a service. Obtaining a prior authorization helps us pay claims faster with no denied charges, or unexpected costs to our members. 

doctor explains drug therapy guidelines to member

Access Drug Therapy Guidelines

To ensure thorough consideration of both quality-of-care and economic issues, some drugs require prior authorization.

We work with a committee of local physicians and pharmacists to identify medications that should require this kind of authorization and to develop the medical criteria used to determine when coverage is appropriate.

Useful Links

Preventive Services

Access information about our preventive services and recommendations.
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Partners in Practice

Get help balancing your business practice with your patients' needs. 
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Transparency Requirements

Learn about transparency legislation.
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OIG Alert About Charging Extra for Covered Services

Stay informed on industry news pertaining to providers, suppliers and physicians.
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FAQ: NYS Opioid Legislation Inpatient SUD

Initial 14 days of inpatient substance abuse disorder treatment.
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Provider Manuals

Blue Shield Dental Manual

Learn about our dental products, claims information, and provider reimbursement process.
View the Blue Shield Dental Manual

Provider and Facility Reference Manual

Get information about our products, services, policies, and procedures.
View Provider and Facility Reference Manual


Office Administrative Guidelines

Print, save or view our office administration documents.
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Practice Guidelines

Learn about our practice guidelines.
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COVID-19 Vaccination Guidance

Resources and information for COVID-19 vaccination.
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