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.
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.
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.
Partners in Practice
Get help balancing your business practice with your patients' needs.
OIG Alert About Charging Extra for Covered Services
Stay informed on industry news pertaining to providers, suppliers and physicians.
FAQ: NYS Opioid Legislation Inpatient SUD
Initial 14 days of inpatient substance abuse disorder treatment.
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.